Salvaging the transected hypoglossal nerve using descendens hypoglossi in patients undergoing hypoglossal-facial nerve anastomosis for facial palsy: a randomized clinical trial.

Autor:	Tang Y; Departments of1Neurosurgery and.; 2The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai., Chen Z; Departments of1Neurosurgery and.; 2The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai., Zhu J; Departments of1Neurosurgery and.; 2The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai., Zhao H; Departments of1Neurosurgery and.; 2The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai., Ying T; Departments of1Neurosurgery and.; 2The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai., Wang B; Departments of1Neurosurgery and.; 2The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai., Zhu W; Departments of1Neurosurgery and.; 2The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai., Wang H; Departments of1Neurosurgery and.; 2The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai., Cai X; Departments of1Neurosurgery and.; 2The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai., Shen Y; Departments of1Neurosurgery and.; 2The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai., Zhou P; Departments of1Neurosurgery and.; 2The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai., Chang B; Departments of1Neurosurgery and., Xia W; Departments of1Neurosurgery and., Wei X; Departments of1Neurosurgery and., Wang X; Departments of1Neurosurgery and., Zhang X; Departments of1Neurosurgery and.; 2The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai., Zhong J; Departments of1Neurosurgery and.; 2The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai., Wang X; 3Department of Neurosurgery, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou.; 4Institute of Neuroscience, Zhengzhou University, Zhengzhou., Fu X; 3Department of Neurosurgery, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou.; 4Institute of Neuroscience, Zhengzhou University, Zhengzhou., Wang D; 5Radiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai., Liu M; 5Radiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai., Zhang W; 6Hongqiao International Institute of Medicine, Shanghai Tongren Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai; and.; 7School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China., Li S; Departments of1Neurosurgery and.; 2The Cranial Nerve Disease Center of Shanghai Jiao Tong University, Shanghai.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery [J Neurosurg] 2024 Jul 26; Vol. 141 (6), pp. 1578-1586. Date of Electronic Publication: 2024 Jul 26 (Print Publication: 2024).
DOI:	10.3171/2024.4.JNS232971
Abstrakt:	Objective: Hypoglossal-facial nerve anastomosis (HFA) is the most commonly used surgical treatment for severe facial palsy that does not respond to conservative treatments. A major complication of HFA is the loss of tongue function. The authors aimed to evaluate whether anastomosing the transected hypoglossal nerve using the ramus descendens hypoglossi could prevent tongue deviation and dysfunction in patients undergoing HFA. Methods: In this randomized trial, adult patients with severe peripheral facial palsy (House-Brackmann grade V or VI) who did not respond to at least 6 months of conservative treatment were randomized at a 1:1 ratio to undergo either HFA alone (control group) or HFA plus anastomosis between the hypoglossal nerve and descendens hypoglossi (intervention group). The primary endpoint was tongue deviation angle at 12 months. Key secondary endpoints included tongue disability (chewing difficulty, swallowing defect, and articulation defect), tongue disability index (TDI; range 1-4, with a higher score indicating more severe disability), and facial nerve function. Results: Twenty patients were enrolled (10 in each group). At 12 months, the tongue deviation angle was significantly lower in the intervention group than in the control group (7.8° ± 5.1° vs 23.6° ± 9.6°, p < 0.001). Although not statistically significant, the intervention group had lower rates of chewing difficulty (1/10 vs 3/10, p = 0.58), swallowing defect (1/10 vs 5/10, p = 0.14), and articulation defect (2/10 vs 6/10, p = 0.17). TDI was significantly lower in the intervention group (1.5 ± 0.6 vs 2.5 ± 0.3, p < 0.001). The percentage of the patients achieving House-Brackmann grade II or III was 80% in each group. Conclusions: Anastomosis of the descendens hypoglossi to the transected hypoglossal nerve attenuated tongue deviation in patients undergoing HFA for facial palsy, without compromising facial nerve function. Clinical trial registration no: ChiCTR2000034372 (Chinese Clinical Trials Registry).
Databáze:	MEDLINE
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