The Establishment And Clinical Application Of A New Surgical Method For Repairing Facial Paralysis By Combined Hypoglossal-facial Nerve Anastomosis And Ansa Cervicalis-hypoglossal Nerve Anastomosis

Objective Peripheral facial paralysis affects patient's appearance,reduces their social adaptability,and impairs their quality of life and health both physically and mentally.Hypoglossal-facial nerve anastomosis(HFA)is a commonly used facial paralysis repair surgery,which can restore the patient's dynamic and static feature,but the classic HFA surgery will inevitably cause hypoglossal nerve dysfunction.This study proposes a new surgical approach for the treatment of peripheral facial paralysis with a combination of both hypoglossal-facial nerve anastomosis and ansa cervicalis-hypoglossal nerve anastomosis.That is,on the basis of classic HFA,the superior root of the ansa cervicalis is cut off and anastomosed to the hypoglossal nerve stump,in order to repair part of the function of the hypoglossal nerve on the affected side,and strive to improve the quality of life of patients with facial paralysis.Methods Through the clinical anatomical study of the facial nerve trunk,the cervical segment of the hypoglossal nerve and the ansa cervicalis,the anatomical layer,trend,length,transverse diameter and branch of the related nerves were learned,and the feasibility of the new operation was discussed.The distance between nerves and adjacent structures was observed and measured.The new method was applied in clinic to verify the feasibility,effectiveness and safety.Results 1.The transverse diameter of the hypoglossal nerve entering the submandibular triangle is 2.79±0.32mm,and the average cross-sectional area of the nerve fibers was 5.35±1.37mm~2,which is similar to the transverse diameter of the facial nerve in stylomastoid foramen(2.68±0.23mm)and its average cross-sectional area of the nerve fibers(4.85±0.91mm~2),so the end-to-end anastomosis is feasible.The average transverse diameter of the distal end of the ansa cervicalis was 1.87±0.14mm,and the cross-sectional area of the fibers was 2.30±0.38mm~2,which could also be replaced to the hypoglossal nerve.2.The average length of the facial nerve trunk is 16.63±2.50mm,and the length of the horizontal hypoglossal nerve can reach 35.21±7.67mm.The sum of the two is far greater than the distance from the facial nerve to the hypoglossal nerve(35.20±5.55mm),which is feasible for tension-free anastomosis.The length of the superior root of the ansa cervicalis is 51.52±10.87mm.The distance from the hypoglossal nerve has the superior root of the ansa cervicalis to the hypoglossal nerve into the submandibular triangle is 28.17±6.51mm.which also met the needs of transplantation.3.The posterior auricular artery,posterior belly of digastric,the occipital artery,etc.can be used as a marker to find the facial nerve trunk and the hypoglossal nerve.4.A total of 10patients were included in the study for this new technique.The average follow-up was 7.6 months.80%patients recovered well(up to HB II-III).None of the patients had significant speech and swallowing disorders.Conclusion This surgical method is operable,safe,effective,and has a definite repairing effect on hypoglossal nerve function.It can be used as a new surgical method of facial paralysis for clinicians to choose.