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Suboccipital-facial Anastomosis as a Proposition of the New Method of Facial Nerve Repair - Anatomic study

Author(s): Kamil Krystkiewicz, Tomasz Wojciechowski, Adrian Dro?d?, Tymon Skadorwa, Bogdan Ciszek, Marek Harat, Marcin Tosik

Background

A facial palsy is a cause of an aesthetical and functional problem. An operative technique used the most commonly in particular cases is a hypoglossal-facial anastomosis. However, a function of a tongue in these patients is usually not entirely preserved. Authors sought the solution for that neurological deficit, exploring the anatomical conditions to perform the anastomosis between the facial and the suboccipital nerve.

Materials and methods

The study was performed on the 5 cadavers (10 sides). In the first step, antromastoidectomy was performed. Next, incision was prolonged to the C2 level. The suboccipital nerve was microsurgically dissected. The facial nerve was transferred to the suboccipital nerve, where the anastomosis was performed.

Results

The anastomosis was possible in every case. The measurements were divided into 3 groups. The first group are three distances describing the extent of the antromastoidectomy: superior - 22±0.7 mm, posterior - 21±2.8 mm and anterior margin of procedure - 28±4.2 mm. The second group were the topographical distances crucial for identification of the neural structures: between the styloid process and the tip of mastoid process - 34±0.6 mm, from the stylomastoid foramen to the tip of mastoid process - 18±0.3 mm, from stylomastoid foramen to the suboccipital nerve - 34±0.6 mm. The last one were diameters of the nerves: suboccipital - 2.5±0.7 mm and facial nerve - 2.5±0.7 mm.

Conclusions

The study has revealed that it is possible to perform suboccipital-facial anastomosis. Nevertheless, the functional assessment has to be investigated in further studies.

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