The Laryngoscope V C 2013 The American Laryngological, Rhinological and Otological Society, Inc. Hypoglossal-Facial-Jump-Anastomosis Without an Interposition Nerve Graft Dirk Beutner, MD; Jan C. Luers, MD; Maria Grosheva, MD Objectives/Hypothesis: The hypoglossal-facial-anastomosis is the most often applied procedure for the reanimation of a long lasting peripheral facial nerve paralysis. The use of an interposition graft and its end-to-side anastomosis to the hypo- glossal nerve allows the preservation of the tongue function and also requires two anastomosis sites and a free second donor nerve. We describe the modified technique of the hypoglossal-facial-jump-anastomosis without an interposition and present the first results. Study Design: Retrospective case study. Methods: We performed the facial nerve reconstruction in five patients. The indication for the surgery was a long-stand- ing facial paralysis with preserved portion distal to geniculate ganglion, absent voluntary activity in the needle facial electro- myography, and an intact bilateral hypoglossal nerve. Following mastoidectomy, the facial nerve was mobilized in the fallopian canal down to its bifurcation in the parotid gland and cut in its tympanic portion distal to the lesion. Then, a tensionless end-to-side suture to the hypoglossal nerve was performed. The facial function was monitored up to 16 months postoperatively. Results: The reconstruction technique succeeded in all patients: The facial function improved within the average time period of 10 months to the House-Brackmann score 3. Conclusion: This modified technique of the hypoglossal-facial reanimation is a valid method with good clinical results, especially in cases of a preserved intramastoidal facial nerve. Key Words: Facial palsy, facial nerve, hypoglossal nerve, interposition graft. Level of Evidence: Level 4. Laryngoscope, 00:000–000, 2013 INTRODUCTION The most-established nerve transfer technique for the reinnervation surgery of a long-lasting facial paraly- sis is a hypoglossal-facial-anastomosis, usually using interposition nerve grafts. 1,2 The use of a hypoglossal nerve as an axon-donor for reinnervation is advanta- geous for many reasons: The course of the hypoglossal nerve, its caliber, and its anatomical localization prevent the extensive tissue dissection and allow for the per- formance of a tense-free nerve suture (Fig. 1). Further- more, due to the neighboring brainstem nuclei of the hypoglossal and the facial nerve and the neuronal brain- plasticity, a favorable functional postoperative outcome is described. 3–5 The very first method of the transposition and end- to-end-suture of the hypoglossal nerve to the proximal trunk of the facial nerve was described by Conley et al. in 1979 1,6 (Fig. 1b). Because of the lost unilateral tongue function and atrophy, this method was replaced by an end-to-side hypoglossal-facial nerve suture. This tech- nique was modified by use of a free interposition nerve graft, usually of the great auricular nerve, which was sutured end-to-end to the distal facial nerve and end-to- side to the incised (1/3 to 1/2) hypoglossal nerve 7 (Fig. 1c). Today, this method is favored, but the presence of two anastomosis sites may influence the reinnervation quality and time. 1,2 Furthermore, loss of sensation is a drawback of this technique. Here, we describe a modified technique of the hypo- glossal-facial nerve anastomosis without an interposi- tional graft and present our first results. MATERIALS AND METHODS Indication This technique was used in patients with a peripheral uni- lateral facial paralysis with a preserved bilateral hypoglossal nerve function. The lesion of the facial nerve could be localized proximal or at the level of the geniculate ganglion. Our tech- nique required an intact facial nerve distal to injury in order to have a functional, noninjured nerve to carry the hypoglossal fibers. The indication for the facial nerve reconstruction was raised, if the paralysis was present after the injury for less than 2 years, and if an absent electromyographic voluntary ac- tivity was recorded in the repeated needle electromyography (EMG) of the mimic muscles (frontalis, orbicularis oculi, zygo- maticus or nasalis muscle, and depressor anguli oris muscle). We had to make an exception for one patient on his request and From the Department of Otorhinolaryngology, Head and Neck Sur- gery, University of Cologne, Cologne, Germany. Editor’s Note: This Manuscript was accepted for publication March 1, 2013. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Dirk Beutner, MD, University of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, Kerpener Str. 62, 50924 Cologne, Germany. E-mail: dirk.beutner@uk-koeln.de DOI: 10.1002/lary.24115 Laryngoscope 00: Month 2013 Beutner et al.: A Modified Hypoglossal-Facial-Jump Anastomosis 1