Islamov RR, Chintalgattu V, Pak ES, Katwa LC, Murashov AK (2004)

Induction of VEGF and its Flt-1 receptor after sciatic nerve crush injury. Neuroreport. 15:2117-21.

ÖZGEÇMİŞ

Bahadır Murat Demirel 17.02.1980 tarihinde İzmit’te doğdu. İlköğrenimini Kütahya Atatürk ilköğretim okulunda, orta ve lise öğrenimini ise Kütahya Ali Güral Anadolu Lisesi’nde 1998 yılında tamamladı. Hacettepe Üniversitesi Fen Fakültesi Biyoloji Bölümünden lisans derecesi ise 2002 yılında mezun oldu. 2005 yılında Akdeniz Üniversitesi Tıp Fakültesi Anatomi Anabilim Dalı’nda yüksek lisansını tamamlayıp, 2006 yılında aynı bölümde doktoraya başladı. 2002 yılından beri Akdeniz Üniversitesi Tıp Fakültesi Anatomi Anabilim Dalın’da araştıma görevlisi olarak çalışmaktadır.

AnnalsofAnatomy193 (2011) 304–313

ContentslistsavailableatScienceDirect

AnnalsofAnatomy

j o u r n al hom e p a g e :w w w . e l s e v i e r . d e / a a n a t

The

hypoglossal–facialnerverepair

asamethod

toimproverecovery

ofmotor

functionafter

facialnerveinjury

UmutOzsoya_,ArzuHizaya_{,BahadirMuratDemirel}a_,OzlemOzsoyb_{,SureyyaBilmenSarikcioglu}c_,

MuratTurhand_{,LeventSarikcioglu}a,∗

a_{DepartmentofAnatomy,AkdenizUniversityFacultyofMedicine,07070Antalya,Turkey} b_{DepartmentofPhysiology,AkdenizUniversityFacultyofMedicine,07070Antalya,Turkey} c_{DepartmentofBiochemistry,AkdenizUniversityVocationalSchoolofHealth,07070Antalya,Turkey} d_{DepartmentofOtorhinolaryngology,AkdenizUniversityFacultyofMedicine,07070Antalya,Turkey}

a r t i c l e i n f o

Articlehistory:

Received13December2010

Receivedinrevisedform3January2011 Accepted5January2011 Keywords: Hypoglossalnerve Facialnerve Recoveryoffunction s u m m a r y

Nerverepairafterfacialnerveinjuryprovidesneuralinputtothedistalfacialnerveandfacialmus-

culatureviaavarietyofmotornervessuchashypoglossal,spinalaccessory,massetericbranchofthe

trigeminalnerveandmotorbranchesofthecervicalplexus.Themostcommonlyusedprocedureisthe

hypoglossal–facialnervetransfer.Thiscross-nerveparadigmisauniquenerverepairmethodasone

motornervetakesoverthefunctionofanothermotornerve.Thehypoglossal–facialnerverepairwas

reviewedbymeansofhistory,terminology,technicalvariations,anditscapacityforrecoveryoffunction.

© 2011 Elsevier GmbH. All rights reserved.

1. Introduction

Facialinjuriesarecommonplaceintoday’ssociety.Motorvehi- cleaccidents,accidentalinjuries,andfallscomprisethemajorityof causesforcomplexfacialwounds(ThallerandMcDonald,2004). Apartfromtraffic-accident injuries (temporal bone fracturesor lacerationsoftheface),mostchronicfacialnervelesionsarepost- operative(radicalparotidectomy,petrousbonesurgery,removalof thecerebellopontineangletumors,andiatrogenicinjury)(Bascom et al., 2000; Gharabaghi et al., 2007; Guntinas-Lichius, 2004; Guntinas-Lichiuset al., 2007;Hundeshagen, 2006; Skouras and Angelov,2010;Soodetal.,2000).

Themaingoalofanysurgicaltechniqueistorestorethesymme- tryofthefacenotonlyduringrestbutalsoinexpressingemotion andvoluntarymotionssuchassmilingandeyeclosure.Severeand long-standingfacialparalysisandlossoffacialexpressionisasocial handicapand leadstosignificantdeterioration inquality oflife owingtoseriousaesthetic,psychologicalandeconomichardships (MayandSchaitkin,2000;TerzisandKonofaos,2008).Regretfully, despitethe numerous microsurgical and neuro-otologicaltech- niquesproposedintheliterature,theunderstandingofdifferent aspectsofnerveregrowthandfacialreanimationremainsachal- lengeforthereconstructivesurgeon(TerzisandKonofaos,2008).

∗ Correspondingauthor.Tel.:+902422496952;fax:+902422274482. E-mailaddresses:sarikcioglu@akdeniz.edu.tr,sarikcioglul@yahoo.com

(L.Sarikcioglu).

Furthermore,despitetheuseofadvancedtechniques,cerebello- pontineanglesurgicalinterventions(e.g.duringacousticneuroma removal)stillresultinapostoperativefacialmotordeficitowingto anastonishinglyfrequent(20–40%)facialnerveinjury.Ofcourse, duringremovaloffacialnerveschwannoma,theresectionofthe facial nerve is inevitable (Magliulo et al., 2001). Several tech- niqueshavebeenproposedtorepairfacialnervedeficit,suchas nervetranspositionwiththehypoglossalnerve,cross-facenerve graft, muscletransposition (temporalis, masseter muscles),and freemuscleflap.Eachofthetechniqueshasspecificindications, contraindicationsandcomplications(Araietal.,1995;Atlasand Lowinger,1997;ConleyandBaker,1979;Mayetal.,1991;Pensak et al., 1986; Pitty and Tator, 1992; Sawamura and Abe, 1997; Schaitkin et al., 1991), but the quality of the reanimated face hasbeenamatterofcontroversy.Usually,functionalrecoveryof voluntarycoordinated movementsof all42 facial muscles, and emotional expressionof theface following repairof transected facial nerve remains disappointing in human patients(Ferreira etal.,1994;KerrebijnandFreeman,1998;RobinsonandMadison, 2005; Robinson and Madison, 2009; Vaughan and Richardson, 1993;Zochodne,2008).Asurgicaltechniquetoobtainoptimalcos- meticresults,suchasanaturalsmilewithoutsynkinesis,hasyetto bedeveloped(Schaitkinetal.,1991).

Whentheproximalstumpofthefacialnerveisnotavailablefor directrepair,surgicaltranspositionsofcranialnervestothedistal facialnervestumparetheonlyfeasiblereconstructionapproach. Forthispurpose,severalcranialnerveshavebeenemployedfor reinnervationofthedistalfacialnervestump.Thespinalaccessory,

U.Ozsoyetal./AnnalsofAnatomy193 (2011) 304–313 305 glossopharyngeal,andtrigeminalnerveshaveallbeendescribed

aspotentialdonors,thoughnonehasgainedgreatpopularitysince theycausemoremorbidityinthedonorregionandshowlesssat- isfactoryresults(Hadlocketal.,2005).Amongthesenerves,the neuralcompatibilityachievedwiththehypoglossalnervewasbet- terthanthatwiththeotherones,mainlyduetotheirfunctional similaritiestothefacialnerve:bothtongueandfacialmusclehave closecorticalrepresentation (Chen et al.,2000; Hammerschlag, 1999;MayandSchaitkin,2000).

Thisreviewarticlewillfocusonhypoglossal–facialnerverepair asoneofawidevarietyofsurgicaltherapiesavailabletorecon- structivesurgeonsforsuccessfulfacialnerverefunctioning.

2. Terminology

Misapplied,orsometimespatentlyincorrecttermsandwords havefoundtheirwayintocommonusageintheliterature;some examples of these have been foundin journals and textbooks over theyears. This istrue of thefrequentlyused term “anas- tomosis”betweentwonervesinanypartofthebody. Theterm “anastomosis”hasbeenusedfornervousconnectionsfromGalen’s timeuntilthe“JenaNominaAnatomica”.AccordingtoStedman’s MedicalDictionary,theterm“anastomosis”referstoa“unionof thetwohollowstructures”.Thisdefinitiondoesnotincludesolid structuresuchas nerves(MenovskyandvanOverbeeke, 1997). Although“hypoglossal–facialanastomosis”is a widelyaccepted term,someauthorsprefertousethecorrectterm.Darrouzetetal. (1999)usedtheterm“side-to-endhypoglossal–facialnerveattach- ment”throughouttheirstudyandabbreviatedthistermasHFA beingthecommonabbreviationforhypoglossal–facialanastomo- sis.MenovskyandvanOverbeeke(1997)putitmoreclearlyand statedthattheappropriatetermshouldbe“repair”,“reconnection”, or“reconstruction”.

Inaccordance,wewillavoidtheuseof“anastomosis”todenote nerverepairinthispaper.

3. History

Theideaoftranspositionofanalternativemotornervedates backto1895.Zachariasz Thomasz Drobnikis creditedwiththe firstsuccessfulreconnectionofthespinalaccessorynervetothe facialnervein1879(MayandSchaitkin,2000;TerzisandKonofaos, 2008).Interestingly,itturnsoutDrobnikwasinhighschoolatthe timeanditispostulatedthatthiswasatypographicalerror.Itisnow assumedthattherealdateis1899(RossonandRedett,2008;Van deGraafetal.,2009).Therefore,itisconcludedthatDrobnikwas notthefirsttooperateonthefacialnervein1899.Instead,thefirst wasSirCharlesAlfredBalance(Streppeletal.,2000;VandeGraaf etal.,2009).In1895,Dr.Balanceoperatedan11yearoldboyfor left-sidedotitismediaandparalyzedthefacialnerveiatrogenically. Sixmonthslater,Dr.Balancere-operatedtheboyandreconstructed hisfacialnerve.Forthispurpose,heexposedthespinalaccessory nerve,inciseditssheathandfixedtheremnantsofthefacialnerve totheaccessorynervebymeansoffinesilksutures(VandeGraaf etal.,2009).

Theconceptofusageofthehypoglossalnerveforreanimationof thefacialnervewasfirstproposedbyKörteandBernhadtin1901 (MayandSchaitkin,2000).Dr.Körteoperatedonafemalepatient sufferingfromfacialparalysissecondarytoinfectiouspetrositisand attachedtheperipheralfacialstumptothesideofthehypoglos- salnerve byinterpositionof afree nervegraft.After6months, initialfacialmovementsappeared.Theipsilateraltonguebecame

sectionofthehypoglossalnerve(Reboletal.,2006).Theimportance ofsparingpartofthehypoglossalnervewasoriginallyemphasized byZehmandHartenau(1981),butMayetal.(1991)definitively refined,popularized,andactuallynamedtheinterpositional-jump grafttechniquein1991(Ferraresietal.,2006).Inlasttwodecades, somemodificationsofthehypoglossal–facialrepairtechniquehave alsobeenproposedintheliterature(Atlasand Lowinger,1997; Darrouzetetal.,1999;Ferraresietal.,2006).