2025年 · 第41卷第07期

Facial nerve palsy seriously affects the quality of life and physical and mental health of patients, among which the treatment of severe facial nerve palsy with House-Brackmann (HB) grade V ~ VI requires surgical intervention^[1,2]。 According to the etiology, course of disease, severity and the patient's own requirements, there are many ways of surgical treatment. Among them, facial nerve replacement transplantation is widely used, which is suitable for patients with injured proximal central end of facial nerve, but injured distal facial nerve is still intact and facial muscle motor endplate function is normal^[3,4,5]。 Common donor nerves include hypoglossal nerve, accessory nerve and masseter nerve, among which hypoglossal-facial anastomosis (HFA) is the most widely used^[6,7,8,9,10]。 The distal end of the hypoglossal nerve was completely severed by traditional HFA and then anastomosed with the extracranial main trunk of the facial nerve^[8]。 This procedure takes the main trunk of hypoglossal nerve as the donor nerve reinnervated by facial muscle, and has the advantages of sufficient amount of donor nerve fibers, close cross-sectional area of donor and recipient nerves, adjacent anatomical sites, etc., and has a definite efficacy in recovering facial nerve function. However, the disconnection of hypoglossal nerve will inevitably lead to the dysfunction of ipsilateral tongue muscle, and even cause hemilateral tongue muscle atrophy, which will seriously affect the chewing, swallowing and speech functions of patients^[11,12]。 In order to avoid this defect of traditional HFA, a variety of improved surgical procedures have been proposed successively, including, (1) Bridging method: that is, using free nerves (such as sural nerve or great auricular nerve) to bridge between hypoglossal nerve and facial nerve, and perform end-to-side anastomosis with hypoglossal nerve to avoid its complete dissection. However, this procedure has two anastomosis and the number of donor fibers is reduced, which is not only not conducive to the reconstruction of facial nerve function, but also requires the sacrifice of another nerve for bridging, and the surgical trauma is greater^[6]。 (2) Partial hypoglossal nerve method: that is, part of the fibers are used for facial nerve anastomosis after longitudinal incision of the hypoglossal nerve, which causes great damage to the hypoglossal nerve fibers^[12]。 (3) Facial nerve transposition method: that is, the vertical segment of the facial nerve in the temporal bone is revealed by grinding off the mastoid process, and then it is transposed downward, so that it can directly anastomose with the hypoglossal nerve end-to-side. This procedure avoids some of the defects of bridging method, but end-to-side anastomosis also has the disadvantage of insufficient number of hypoglossal nerve donor fibers, and the abrasion of mastoid also increases the difficulty of surgery and the risk of related complications^[13,14,15]。 Therefore, how to improve the traditional HFA procedure to ensure the efficacy of facial nerve paralysis repair and avoid the damage of tongue muscle function has become a research hotspot in this field.