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Hypoglossal-Facial Side-to-End Neurorrhaphy With Concomitant Masseteric-Zygomatic Nerve Branch Coaptation and Muscle Transfer for Facial Reanimation: Technique and Case Report.

BACKGROUND
Hypoglossal-facial direct side-to-end neurorrhaphy has become widely used for facial reanimation in patients with irreversible facial nerve damage. Although this procedure achieves good restoration of facial function, it has disadvantages such as mass movement and lack of spontaneity.


OBJECTIVE
To present a new facial reanimation technique using hypoglossal-facial direct side-to-end neurorrhaphy with concomitant masseteric-zygomatic nerve branch coaptation and secondary muscle transfer to reduce mass movement and achieve a spontaneous smile in patients with facial paralysis.


METHODS
This article describes a novel facial reanimation technique that employs hypoglossal and masseteric nerve transfer combined with secondary vascularized functional gracilis muscle transfer.


RESULTS
Details of the technique are reported in a patient with complete facial paralysis after brain surgery. The hypoglossal nerve was partially served and connected to the mastoid segment of the facial nerve by side-to-end anastomosis to restore facial symmetry. A nerve supplying the masseter muscle was coapted with a zygomatic branch by end-to-end anastomosis to restore voluntary movement of the oral commissure, as well as to assist with eye closure. A cross face sural nerve graft was connected to zygomatic branches on the healthy side. In the second stage, a vascularized functional gracilis muscle graft was transplanted using the cross face nerve graft as the donor nerve to restore a natural smile.


CONCLUSION
Hypoglossal-facial neurorrhaphy with concomitant masseteric-zygomatic nerve branch coaptation and muscle transfer is an alternative facial reanimation technique that reduces mass movement and achieves a natural smile.