PMC3347494_01
Preoperative (a-c) images of the presented case. House and Brackmann grade 6 left facial palsy was observed 13 months after the beginning of the spontaneous left facial palsy
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F2
Signs of mimic muscle atrophy were evident on the affected side of the face [Figure 2].
Classical and partial direct hypoglossal-facial anastomosis technique. The classical technique was employed in the historical cases presented in Figure 1 and has been the procedure of choice for facial reanimation for more than 100 years, since its original description by Korte in 1903. By contrast, the partial direct hypoglossal-facial anastomosis was described in 1997, and its main advantage is avoiding severe tongue atrophy. Upper left and right squares: classical technique with complete sectioning of the hypoglossal nerve. Bottom left and right squares: partial hypoglossal nerve sectioning, and anastomosis with a "longer" facial nerve obtained after drilling the mastoid bone. The main advantage of the partial section of the hypoglossal technique is avoiding the tongue atrophy
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F3
At that moment, a facial reinnervation procedure was offered to the patient, namely, a partial direct hypoglossal to facial nerve transfer involving mastoid bone drilling [Figure 3].
Postoperative (a-c) images of the presented case. A good symmetry at rest, good active movement, and no tongue atrophy were obtained
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F4
A grade 3 of the HB facial palsy scale was stated at that moment [Figure 4].