Comparison of End-To-End Descending Hypoglossal-Facial Anastomosis And End-To-Side Hypoglossal-Facial Anastomosis For Facial Paralysis After Vestibular Schwannoma Surgery

Background: We aimed to compare the outcomes of end-to-end descending hypoglossal-facial anastomosis (eeDHFA) and end-to-side hypoglossal-facial anastomosis (esHFA) in patients with complete facial paralysis after vestibular schwannoma (VS) surgery. Methods: : This retrospective study included 52 patients with complete nerve damage identified during previous VS removal or on electromyography during follow-up. Postoperative facial palsy was evaluated using the House-Brackmann (HB) facial nerve grading system. Postoperative hemiglossal atrophy and swallowing were assessed using Martins’ grading system and the water-swallowing test, respectively. Hoarseness was also recorded if present. Results: : The median time from VS resection to anastomosis was not significantly different between the two groups ( p =0.062). The median follow-up time showed no significant differences between groups (eeDHFA: 17 months; esHFA: 14 months; p =0.446). We found no significant differences in the number of favourable (HB I-III) or unfavourable (HB IV-VI) outcomes for facial nerve function in the last follow-up ( p =0.924). Only one patient from each group developed hemi-tongue myoparalysis. No patient experienced swallowing dysfunction or hoarseness. Conclusions: : We concluded that eeDHFA is as effective as esHFA as a surgical method for the treatment of facial palsy after VS surgery. Since eeDHFA represents a simple technique for facial reanimation, it could therefore be considered as an alternative surgical option for patients affected by complete facial paralysis after VS surgery.