Restoring Facial Expression and Function
Facial paralysis, with its impact on expression, communication and quality of life, represents a significant challenge. In SurgSchool, the leading app for online surgical training, this surgery is presented: the lateral terminus hypoglossal-facial connection. Dr. Carlos Martín Oviedo, a leading specialist, demonstrates in a detailed videotaped surgery how this microsurgical technique restores facial function in selected patients.
What is the Hypoglossal-Facial Connection?
The hypoglossal-facial connection is a procedure of neurotization, which involves redirecting a healthy nerve (the hypoglossal nerve, which controls the tongue) to donate axons to the damaged facial nerve. The end-to-side technique, used by Dr. Martín Oviedo, preserves tongue mobility by sectioning only one-third of the hypoglossal nerve fibers. This innovation, described simultaneously by Darrouzet (France) and Atlas (Sydney) in 1996, has proven to be an effective alternative to nerve grafting.
Surgery Step by Step: Anatomical Precision and Microsurgery
The transcription of Dr. Martín Oviedo's surgery in SurgSchool reveals the meticulousness of each stage:
- Approach and Exposition: A cervico-mastoid incision is made to access the hypoglossal and facial nerves. The hypoglossal is identified and dissected proximally, passing a vessel loop for manipulation. The digastric muscle is also dissected, a key step for the posterior transposition of the facial nerve.
- Facial Identification and Release: The facial nerve is identified as it exits the parotid gland. A milling mastoid to expose the vertical and elbow portions of the facial nerve, almost reaching the geniculate ganglion segment. The digastric crest is identified, an anatomical landmark for the release of the facial nerve.
- Facial Rerouting: Using microsurgical instruments, the facial nerve is carefully released from its bony bed in the mastoid, sectioned distally (slightly before the elbow), and mobilized to the hypoglossal nerve. Extreme care must be taken at this stage to preserve the integrity of the blood vessels supplying the facial nerve, which are concentrated in three key areas. The stylomastoid foramen is also released to facilitate the rerouting.
- Nervous Connection: Approximately one-third of the hypoglossal nerve fibers are sectioned. The facial nerve is sutured to the hypoglossal nerve, connecting the epineurium and directing the suture toward the proximal fibers of the hypoglossal muscle to facilitate axonal growth toward the facial muscle. Approximately three stitches with a very fine monofilament (9/0) are used.
- Stabilization and Closure: Fibrin glue (Tissucol) is applied to provide greater suture stability. A small drain is left, and the incision is closed with staples.
SurgSchool: A Window to Surgical Knowledge
Dr. Martín Oviedo's hypoglossal-facial connection surgery in SurgSchool It is an invaluable resource for:
- Residents and Surgeons in Training: It allows you to understand the complex anatomy and detailed steps of this reconstructive microsurgery.
- Facial Nerve Specialists: It offers the opportunity to observe an expert's technique and learn about best practices.
- Healthcare professionals: Facilitates understanding of surgical options for facial paralysis and their impact on patient recovery.
SurgSchool It has established itself as a leading online surgical training platform, providing access to complex, highly specialized procedures.
DOWNLOAD THE APP NOW SURGSCHOOL and access hundreds of surgeries explained by international experts.
