Contribution of the Synkinesis Assessment Questionnaire and the Sunnybrook Facial Grading System to the evaluation of synkinesis after peripheral facial palsy: A STROBE observational study.

OBJECTIVES: The main aim of the study was to determine whether the perception of synkinesis by patients with peripheral facial palsy (PFP) matched their clinician's severity assessment. Secondary objectives comprised: (1) to determine whether objective measurement of synkinesis matched the patient's perception; and (2) is to identify factors influencing patients' perceptions. METHODS: This retrospective study took place from January to May 2020. Forty patients (8 per PFP grade, I-V/VI; 20 women, 20 men) filled out the Synkinesis Assessment Questionnaire (SAQ) and were assessed on the Sunnybrook Facial Grading System (SFGS). Photographs were analyzed on MEEI-Facegram software. RESULTS: Perceived synkinesis (total SAQ) matched objective grades (SFGS) (Z=2.89; P=0.004), especially for smiling (Z=3.84; P<0.001) and lip protrusion (Z=3.79; P<0.001). Synkinesis on lip protrusion was a more sensitive indicator of perceived synkinesis than synkinesis on smiling (Z=2.96; P=0.003). Duration (ρ=0.5137; P<0.001) and grade of PFP (Chi2=13.82; P=0.008) heightened the perception of synkinesis. CONCLUSION: Patient-reported outcome measures (PROMs) such as the SAQ are relevant for clinical evaluation.

Tagetes lucida Cav. essential oil and the mixture of its main compounds are antibacterial and modulate antibiotic resistance in multi-resistant pathogenic bacteria.

We evaluated an essential oil (EO) of Tagetes lucida Cav. and the mixture of its main compounds against multi-drug resistant bacteria. We found that EO and the partially reconstituted blend of its main components have antibacterial activity and inhibit antibiotic resistance (ampicillin, chloramphenicol, nalidixic acid, vancomycin and imipenem) in strains of Staphylococcus aureus ATCC 29213 and Pseudomonas aeruginosa HIM-MR01. The T. lucida EO alone or added to the antibiotics showed antimicrobial activity against S. aureus and P. aeruginosa. The EO main bioactive compounds were methyl eugenol (relative abundance in EO: 46·15%), estragole (32·93%), linalool (2·48%) and geraniol (0·33%). The mixture (PREO) of those compounds at those proportions inhibited the growth of P. aeruginosa in 45% at 683·62 µg ml-1 and that of S. aureus in 51·7% at 39·04 µg ml-1 . The PREO had higher antibacterial and modulatory activities than the original EO. In conclusion, we overcame the unpredictability of EO activity (due to their natural variability) by determining which EO components inhibited bacteria and then producing a PREO to generate a reproducible mixture with predictable antibacterial and modulation of resistance activities. Thus, the PREO, and its components, show potential as alternatives to manage multidrug-resistant pathogens.

Ocular and systemic toxicity of high-dose intravitreal topotecan in rabbits: Implications for retinoblastoma treatment.

Although many more eyes of children with retinoblastoma are salvaged now compared to just 10 years ago, the control of vitreous seeding remains a challenge. The introduction of intravitreal injection of melphalan has enabled more eyes to be salvaged safely but with definite retinal toxicity. Intensive treatment with high-dose intravitreal topotecan may be a strategy to control tumor burden because of its cell cycle-dependent cytotoxicity and the proven safety in humans. Therefore, we evaluated the ocular and systemic safety of repeated high-dose intravitreal injections of topotecan in rabbits. Systemic and ocular toxicity was assessed in non-tumor-bearing rabbits after four weekly injections of three doses of topotecan (10 µg, 25 µg, and 50 µg) or vehicle alone. Animals were evaluated weekly for general and ophthalmic clinical status. One week after the last injection, vitreous and plasma samples were collected for drug quantification and the enucleated eyes were subjected to histological assessment. Weight, hair loss, or changes in hematologic values were absent during the study period across all animal groups. Eyes injected with all topotecan doses or vehicle showed no signs of anterior segment inflammation, clinical or histologic evidence of damage to the retina, and ERG parameters remained unaltered throughout the study. Vitreous and plasma topotecan lactone concentrations were undetectable. Four weekly intravitreal injections of topotecan up to 50 µg in the animal model or a 100 µg human equivalent dose were not toxic for the rabbit eye. High doses of topotecan may show promising translation to the clinic for the management of difficult-to-treat retinoblastoma vitreous seeds.

French Society of ENT (SFORL) guidelines. Management of acute Bell's palsy.

AQFThe authors present the guidelines of the French Society of ENT and Head and Neck Surgery (SFORL) regarding the management of Bell's palsy in adults. After a literature review by a multidisciplinary workgroup, guidelines were drawn up based on retrieved articles and group-members' experience, then read over by an independent group to edit the final version. Guidelines were graded A, B, C or "expert opinion" according to decreasing level of evidence. Thorough ENT and neurological clinical examination is recommended in all patients presenting with peripheral facial palsy to confirm diagnosis of Bell's palsy. MRI with gadolinium enhancement should explore the entire course of the facial nerve, if possible within the first month. ENMG should be performed to assess prognosis for recovery. In confirmed Bell's palsy, corticosteroid therapy should be implemented as early as possible (ideally within 72h) at a dose of 1mg/kg/day for 7-10 days. Antiviral therapy should be associated to steroids in patients with severe and early-onset disease and in Ramsay-Hunt syndrome. Isolated antiviral therapy is not recommended. To date, there is no evidence that surgical facial nerve decompression provides benefit.

Circuito del paciente fallecido en el Hospital Garrahan: Implementación de Gestión por procesos y plan de mejora integral / Circuit of the deceased patient at Garrahan Hospital: implementation of process management and a comprensive plan for improvement

Ante circunstancias que concluyen en el fallecimiento de los pacientes, el Hospital Garrahan (HG) debe facilitar el duelo con medidas adecuadas y apropiadas en un contexto de respeto y contención, acompañando preguntas, dudas e incertidumbres familiares, respetando valores, evitando dificultades administrativas y legales. El objetivo fue trabajar sobre el proceso del paciente fallecido para ordenar la normativa histórica, reglamentarla y documentarla agregando avances tecnológicos. Se estableció un circuito que llamamos circuito del paciente fallecido (CPF). Es un proceso que comienza en la inscripción de la defunción, traslado del paciente a la morgue hasta la entrega a la familia. Involucra al hospital de forma transversal. A través del trabajo interdisciplinario, aplicando conceptos y herramientas de gestión, se trabajó un plan de mejora en la gestión del CPF, partiendo de la disposi- ción hospitalaria vigente, adecuando el Protocolo respectivo del Ministerio de Salud del Gobierno de la Ciudad de Buenos Aires, estableciendo registros adecuados en todo el circuito. El diseño metodológico propuesto fue la planificación, desarrollo implementación de un plan de mejora en el CPF de acuerdo a gestión por procesos. Se desarrollaron las siguientes etapas: análisis de la situación de salud que generó la intervención, identificación del proceso en un mapa, identificación de problemas del CPF, revisión y análisis del proceso e implementación del plan de mejora. Este plan de mejora está sustentado en la Disposición N°238/ DME/17

When a patient dies in hospital, Garrahan Hospital should facilitate the process of mourning with adequate and appropriate measures in a context of respect and contention, providing support in case of questions, doubts, and uncertainties of the family, respecting values and avoiding administrative and legal difficulties. The aim of this project was to improve the processes related to the deceased patients organizing historical norms by establishing guidelines and documentation using new technological means. A circuit called circuit of the deceased patient (CDP) was established, consisting of a process that starts at the moment of the registration of death, followed by the transfer of the patient to the morgue, and finishing with the handing over to the family. The process involves the hospital transversally. In an interdisciplinary manner and using different management concepts and tools, a plan of improvement of the management of the CDP was developed, based on the current regulations of the hospital, adapting the protocol of the Ministry of Health of the Government of the City of Buenos Aires, establishing adequate records for the entire circuit. The proposed methodological design consisted of the planning, development, and implementation of a plan for the improvement of the CDP according to process management. The following stages were developed: analysis of the situation that led to the intervention, identification of the process on a map, identification of difficulties in the CDP, process revision and analysis and implementation of the improvement plan. The improvement plan is supported by Disposition N°238/DME/17

Vagal and recurrent laryngeal nerves neuromonitoring during thyroidectomy and parathyroidectomy: A prospective study.

OBJECTIVES: The aim of the study was to stimulate the vagal and the recurrent laryngeal nerves during and after thyroidectomy or parathyroidectomy, to record muscle responses, interpret the electrophysiological modifications and identify prognostic factors for postoperative vocal fold mobility. PATIENTS AND METHODS: A prospective study monitored 151 vagal nerves and 144 recurrent laryngeal nerves in 114 patients. Seven patients (14 vagal nerves) underwent continuous monitoring via an automatic periodic stimulation (APS®) electrode. In 15 patients (21 vagal nerves), the stimulation threshold was studied. Muscle response was recorded on direct vagal and/or recurrent laryngeal nerve stimulation by a monopolar electrode or direct repeated stimulation via an electrode on the vagal nerve. In case of signal attenuation on the first operated side, surgery was not extended to the contralateral side. RESULTS: The vagal nerve stimulation checked inferior laryngeal nerve integrity and recurrent status, without risk of false negatives. The vagal nerve stimulation threshold, before and after dissection, that induced a muscle response of at least 100µV ranged from 0.1 to 0.8mA. Similarity between pre- and post-dissection responses to supramaximal stimulation, defined as 1mA, on the one hand, and between post-dissection vagal and laryngeal recurrent nerve responses on the other correlated with normal postoperative vocal cord mobility. Conversely, muscle response attenuation below 100µV and increased latency indicated a risk of vocal fold palsy. CONCLUSION: Vagal nerve stimulation allows suspicion or elimination of lesions on the inferior laryngeal nerve upstream of the stimulation point and detection of non-recurrent inferior laryngeal nerve. Intermittent monitoring assesses nerve function at the moment of stimulation, while continuous monitoring detects the first signs of nerve injury liable to induce postoperative recurrent nerve palsy. When total thyroidectomy is indicated, signal attenuation on the first operated side casts doubt on continuing surgery to the contralateral side in the same step.

[Facial palsy rehabilitation: Assessment before surgery]. / Réhabilitation de la face paralysée. Bilan préthérapeutique du patient.

A patient who needs a surgery for facial rehabilitation must have a complete assessment. The etiology of the facial palsy must be clear. It is necessary to have a MRI of the facial nerve for the statement of the initial pathology or to search a lesion on the nerve. The facial palsy must be definite which is depending of the delay of the palsy and the etiology. An electromyography must be done. The choice of the procedure depends on the delay of the palsy, the site on the nerve, the associated diseases and the opinion of the patient after a good explanation.

[Hypoglossofacial anastomosis for facial palsy treatment: Indications and results]. / Réhabilitation de la face paralysée par anastomose hypoglosso-faciale. Indications et résultats.

UNLABELLED: Hypoglossofacial anastomosis is a classical surgical procedure for the treatment of facial paralysis when the trunk of the facial nerve cannot be repaired and its peripheral branches are normal. PATIENTS AND METHODS: Between 2004 and 2015, 77 patients were able to benefit from an hypoglossofacial anastomosis. The etiology of the paralysis was mainly the surgery of vestibular schwannoma, tumors of the facial nerve and diseases of the brainstem. A specific and premature speech therapy remediation was realized for all patients in order to preserve the tongue function and to upgrade the facial motricity. RESULTS: Sixty-nine patients could be studied. The House Brackmann grading scale was used to appreciate the result. Thirty-one patients are grade III, 34 grade IV and in only one case the result is a grade V despite the anastomosis works. The main predictive factor for a good result is a small delay between the onset of the paralysis and the surgery for the rehabilitation. The specific physiotherapy upgrades the result with less side effects of the anastomosis. CONCLUSION: Hypoglossofacial anastomosis is a simple and reliable surgical procedure for rehabilitation of paralysed face. The quality of the result is linked with an early surgery and a specific physiotherapy.

French ENT Society (SFORL) guidelines for the management of immunodeficient patients with head and neck cancer of cutaneous origin.

OBJECTIVES: The French ENT Society (SFORL) created a workgroup to draw up guidelines for the management of immunodeficient patients with head and neck cancer of cutaneous origin. The present guidelines cover diagnostic and therapeutic management and prevention of head and neck cancer of cutaneous origin in immunodeficient patients, and in particular in transplant patients and those with HIV infection. MATERIALS AND METHODS: The present guidelines were based on a critical multidisciplinary reading of the literature. Immunosuppression and its varieties are defined. The usual risk factors for skin cancer and those specific to immunodeficiency are presented. The prevention, assessment and management of cutaneous carcinoma, melanoma, Kaposi's sarcoma and lymphoma are dealt with. The level of evidence of the source studies was assessed so as to grade the various guidelines. When need be, expert opinions are put forward. RESULTS: Immunodeficient patients are at higher risk of head and neck skin tumors. The level of risk depends on the type of deficiency; there is an especially high risk of squamous cell carcinoma in transplant patients and of Kaposi's sarcoma in HIV-positive subjects. Various viruses are associated with skin cancers. Skin tumors are often evolutive in case of immunodeficiency, requiring rapid treatment. Management is generally the same as in immunocompetent subjects and should be discussed in a multidisciplinary team meeting. Immunosuppression may need to be modulated. In organ transplant patients, the only class of immunosuppressants with proven antitumoral efficacy are mTOR inhibitors, particularly in cutaneous squamous cell carcinoma. The rhythm of clinical surveillance should be adapted according to the risk of recurrence. Preventive measures should be undertaken. CONCLUSION: Skin cancers in immunodeficiency are highly evolutive, requiring the earliest possible treatment. Immunosuppression may need modulating. As the risk of recurrence may be elevated, careful surveillance should be implemented. Preventive measures should also be undertaken.

[Acoustic analysis of the articulatory disorders of patients affected by peripheral facial paralysis]. / Analyse acoustique des troubles articulatoires chez les patients atteints de paralysie faciale périphérique.

INTRODUCTION: The study of joint disorders in facial paralysis is an important element of support to guide rehabilitation. MATERIAL: The material used for the registration of the database is a digital recorder Zoom H4N (way format, sample rate 44,100 Hz, 16 bit quantization). The microphone used is a Shure Beta 58, super cardioid. All recordings are made in a specific room. METHODS: The annotation of the corpus is done using Praat software and its plug-in EasyAlign order to achieve alignment phonetics. RESULTS: High frequency power ratio (HPR) is a good indicator of the setting in motion of the articulators as the number of explosions of bilabial phoneme was significantly related to the motor of the face and lips, and the score at dynamometer. The VOT was significantly shorter in patients with grade IV and V-VI than in control subjects. The results highlight a significant difference between the values of F3for the vowels /i/ and /y/, depending on the severity of the damage. There is even, for the most severe grades, there are a hundred Hertz difference between F3 of /i/ and that of /y/, which means that these two vowels becomes impossible to discriminate. CONCLUSIONS: If these functional disorders are much discomfort for patients, however, these are not speaking of articulatory disorder in the strict sense, according to the definition of Borel Maisonny. We must therefore focus more specifically to the acoustic analysis of speech in order to check for spectral indices likely to identify these disorders.

[Prosodic analysis of speech of patient affected by peripheral facial paralysis]. / Prosodie et paralysie faciale périphérique.

INTRODUCTION: The aim of study of prosody in facial palsy is to assess the intensity of pathology in suprasegmental viewpoint in order to establish a proper rehabilitation. METHODS: Patients were recorded during a reading and spontaneous speech test and a prosodic observation of speech spectrogram provided by Praat software. RESULTS: The Accentual Groups lowering and significant dysprosodics elements (adverse effects and breaking balance) and a larger amount of disfluencies showed that the prosody of patients with facial palsy is altered because they need to swallow their saliva intentionally. Then, the decrease of Mean Length of Utterance (MLU) and the opinion of the jury highlight a decrease in desire to communicate and a loss of speech informativeness. CONCLUSIONS: In patients with severe facial palsy, there is an impact of swallowing disorder (caused by salivary stasis) on the prosody of speech, with variations in the position of intonations boundaries and the intensity of prosodic marking. This also creates impact on fluency and on the perception of the message by the listener.

[Lengthening temporalis myoplasty for facial palsy reanimation after parotid surgery]. / Réhabilitation de la face paralysée au cours de la chirurgie parotidienne. intérêt de la myoplastie d'allongement du muscle temporal.

AIM OF THE STUDY: Share our experience and our results of lengthening temporalis myoplasty (LTM) for facial palsy reanimation after parotid surgery. MATERIALS AND METHODS: Study of 15 patients after they had had a lengthening temporalis myoplasty, in the same time or after a non conservative parotidectomy of facial nerve. 10 patients suffered from a parotid malignant tumor, one had a jugal epidermoid skin carcinoma invading the parotid, 2 patients had a facial palsy after removal of pleomorphic adenoma recurrence and two patients had a facial nerve schwannoma. 8 patients had a LTM surgery in the same time of the parotid tumoral removal. RESULTS: No recurrence was observed on the 11 patients who had a carcinoma (average follow up: 27 months). The LTM surgery enabled us to obtain good results at rest for 14 patients (93%) and an intermediate result for one person. The ability to smile was described as good for 10 patients (66.6%), intermediate for 4 of them (26.6%) and unsatisfying for 1 person (6,6%). In the group rehabilitation, the results observed are similar, for the patients who had one or two surgical steps. In 3 cases, we noticed an infectious complication, which led us to operate again. In the 8 cases within lengthening was performed in the same time as parotidectomy, there was no additionnal surgical difficulty. CONCLUSION: LTM surgery is an efficient method of rehabilitation. If possible, it should be performed in the same time as tumor removal. As the operational places are different, tumor checking-up and observation are not disturbed by this kind of rehabilitation.

[Smile "forced" smile versus "spontaneous": comparison of 3 techniques of reconstructive surgery of the face. Myoplasty temporal muscle, hypoglossal facial anastomosis and gracilis muscle free flap]. / Sourire "contraint" versus sourire "spontané": comparaison entre 3 techniques de chirurgie réparatrice de la face. Myoplastie du muscle temporal, anastomose hypoglosso faciale et lambeau libre de muscle Gracilis.

The facial palsy cause serious consequences for patients. Studies have also shown that in these patients, the inability to produce an appropriate and spontaneous smile would be a key factor of depression. When facial palsy is considered complete and the nerve cannot be repaired, the patient can benefit from palliative surgery to regain a better quality of life in the aesthetic, functional, and psychological aspects. The hypoglossal-facial anastomosis (AHF), temporal myoplasty (MAT) and gracilis transposition (TG) are the major surgeries currently used for this purpose. The aim of our study is to assess quantitatively and qualitatively the effects of each of these surgeries on the lip mobility and production of smile. From this perspective, we proposed a protocol of an evaluation of facial motricity, of quality of life, and more particularly on the quality and the analysis of the smile. The results underline that there is no significant difference in the recovery of the facial motricity according to the surgery. Only the slower, deferred deadline of recovery at the patients AHF and TG who have to wait several months, it is for the same levels as that of the patients' MAT. A premature and intensive rehabilitation such as the patients of our protocol benefited from it what is nevertheless essential to a good recovery whatever is the surgery.

[Termino-terminal hypoglossofacial anastomosis, indications, results]. / Anastomose hypoglosso-faciale termino-terminale. Indications. Résultats.

OBJECTIVES: Retrospective study about the indications and the results of the end to-end hypoglossofacial anastomosis (AHF tt). MATERIALS AND METHODS: Between 2004 and 2010, 38 patients were able to benefit from an AHF tt. It was about 13 men and 25 women. The mean age was of 40 years and the average deadline of coverage after facial paralysis was of 21.3 months. The etiology of the paralysis was in 47.7% of the cases a surgery for vestibular schwannoma and in 18% of the cases, of the facial nerve schwannoma. Besides the AHF tt, a golden weight was put to 6 of our patients. A specific and premature speech therapy remediation was realized at our all patient's. RESULTS: The beginning of recovery was spread out between 3 and 9 months. The final result was a grade III HB (37%) and IV HB (60%). Only a case of grade VHB was observed. The complications often reported by the AHF tt were very widely decreased by the specific reeducation. CONCLUSION: AHF tt is a particularly reliable technique, for rehabilitation of facial palsy, when the peripheral branches are intact and it, for the deadline 4-years-old subordinate except particular cases.

Facial nerve decompression for idiopathic Bell's palsy: report of 13 cases and literature review.

INTRODUCTION: The prognosis for cases of idiopathic facial palsy is usually good. However, some cases develop disabling sequelae, such as synkinesis or severe facial hemispasm, despite targeted medical treatment. OBJECTIVES: The authors try to achieve that electromyography is useful to identify patients with severe palsy and an unfavourable prognosis. These patients would probably benefit from facial nerve decompression. SETTING: The otolaryngology-head and neck surgery department of Pitié-Salpêtrière Hospital, Paris, a tertiary referral centre. PARTICIPANTS: Thirteen cases undergoing surgery between January 1997 and March 2007. MAIN OUTCOME MEASURES: We describe the electromyographic findings that led to surgery. All patients underwent surgery via a subpetrous approach, within four months of the onset of palsy. Decompression involved the first and second portions of the nerve and the geniculate ganglion. RESULTS: Recovery to House-Brackmann grade III was obtained in all cases at one year follow up. CONCLUSION: These results compared favourably with previous reports. A new therapeutic procedure may allow improved results.

[Bilateral and recurrent facial palsy due to lymphoma: a case report]. / Paralysie faciale périphérique à bascule et lymphome: à propos d'un cas.

OBJECTIVE: To discuss about management of facial paralysis reccurence and to highlight the ENT's important role in the diagnosis of systemic diseases. MATERIAL AND METHODS: This article presents a case report about a controlateral facial palsy recurrence, two months later in a fifty-two year's old woman. This cranial nerves involvement was due to non-Hodgkin lymphoma with neuro-meningeal spreading. The first palsy had completely recovered with steroids. The early recurrence of the palsy and the lymph nodes areas exam lead to the diagnosis. The patient was treated by chemotherapy with good neuromeningeal diffusion. The facial score rapidly improved, according to facial electromyography results. DISCUSSION: Specific biological and radiological explorations are usually carried out in recurrent facial palsy. Complete clinical examination and cerebrospinal fluid study are useful in this case. Moreover it should be preferable to do these explorations before steroid therapy. A diffuse meningeal enhancement on the MRI can complete sometimes clinical and biological data. CONCLUSION: Cranial nerves involvement is sometimes one of the first symptoms of neuro-meningeal lymphoma. Facial palsy reccurence has to conduce ENT pratician to do more specific explorations, of which CSF analysis is required.

[The rehabilitation of the tongue in hypoglossal-facial anastomosis]. / La rééducation de la langue dans l'anastomose hypoglosso-faciale.

UNLABELLED: End to end hypoglossal-facial nerve anastomosis (tt HFA) is a traditional technique for rehabilitation of facial palsy. The sacrifice of the hypoglossal nerve generates a paralysis and an atrophy of the tongue which is thought to lead to speech, chewing and swallowing disorders. In a previous study, we demonstrated that tt HFA does not lead to speech disorders (Gatignol et al 2003). OBJECTIVES: In this work, we were interested in the functional consequences of the lingual atrophy and in the possibilities of rehabilitation with early therapy. MATERIAL AND METHODS: Nine patients were distributed in two groups, in one patients received a specific and early lingual rehabilitation in the other no specific treatment. These two groups (paired with control subjects) were subjected to a series of tests studying the motor function, the articulation (using palatograms). RESULTS: This study highlights the interest of early rehabilitation of the tongue in the first post-operative days. Early rehabilitation was associated with a reduction in lingual atrophy, an improvement in motility of the tongue thus generating a better management of saliva and stagnant food in the oral vestibule on the paralysed side.

[The hypolossal-facial anastomosis in man. A model for studying peripheral and central nervous system plasticity]. / L'anastomose hypoglosso-faciale chez l'homme: un modèle d'etude de la plasticité du système nerveux périphérique et central.

Hypoglossal-facial anastomosis (HFA) is a cross-over between the proximal stump of the hypoglossal nerve (XII) and the distal one of the facial nerve (VII). The hypoglossal axons regrow within the sheaths of facial fibres, allowing the progressive reinnervation of the facial muscles. This model is interesting to study some mechanisms of plasticity of the nervous system for several reasons: 1) It is a quite simple and reproducible model of pathophysiological state. It allows the study of 2) the modifications of the nervous system induced by the HFA, both upwards and downwards to the lesion and 3) the modifications of reflex activities involving intrapontine connections such as the blink reflex. The electrophysiological features of the trigemino-facial (TF) and trigemino-hypoglossal (TG) connections demonstrated that a central reorganisation of the blink reflex (BR) was induced by HFA: the afferent volleys of the TF and TH reflexes elicited by cutaneous and mucosal trigeminal afferents respectively have been shown to project onto common interneurones located within the trigeminal principal sensory nucleus. A long-term prospective study showed: 1) a reinnervation of the facial muscles by the hypoglossal axons is a necessary perequisite for the central reorganisation of BR, 2) a hyperinnervation of the facial muscles by the hypoglossal axons, 3) a transient and regressive cross-innervation of paralyzed face by the healthy contralateral facial nerve.

Hypoglossal-facial nerve anastomosis: dynamic insight into the cross-innervation phenomenon.

The authors investigated the evolution of the dynamic features of the cross-innervation process in patients with complete facial palsy due to facial nerve transection during surgery for acoustic neuroma removal followed by a hypoglossal-facial nerve anastomosis (HFA). Clinical and electrophysiologic investigations were carried out before and over a 3-year period after HFA. Cross-innervation had started by the 10th day, progressed to the seventh to eighth month, then decreased and finally disappeared by the 12th month after HFA. Ipsilateral reinnervation was observed by the fourth month, progressed to the 12th to 18th month, and remained stable for the remainder of the follow-up period.