With this procedure a healthy and non injured nerve, especially suitable for this is the hypoglossal nerve -(motor of the tongue muscles), is redirected in such a way that the paralyzed side of the face is re-innervated. As a result, the function of the affected nerve can be compensated. The newly attached hypoglossal nerve takes over the function of the damaged nerve, reason for degradation of the mimic muscles, leading to the survival of the end-organ (nerve endings). Muscles that are not activated, because of damages of the nerves that innervate them, will gradually be wasted. In the case of a facial paralysis, the mimic musculature can be brought back to life and restored through a successful reconstruction. This though, can only take place in a specific time window, before a “point of no return” is reached. For this reason, our goal is to achieve a revitalization of the facial nerve through microsurgical procedures and as a consequence to save the mimic muscules as soon as possible. By doing so, the denervation time of the muscles will be shortened and therefore the mimic muscle decay avoided. This hypoglossal-facial-jump-nerve anastomosis though is only supportive and does not represent a permanent solution. In its nature it is not physiologic and therefore not ideal. As a result, Plastic surgery currently follows a new therapeutic approach concerning the treatment of facial nerve paralysis where the hypoglossal-facial jump-nerve-anastomosis can be reversed. In this technique (known as a cross-face-transfer), at the same time with the jump-nerve-anastomosis, a donor nerve from the lower leg will be placed under the facial skin,and used to connect the two halves of the face( the healthy half of the face to the paralysed half of the face). After a period of 6 to 8 months, nerve sprouts from the healthy side will grow into the paralysed side. At this point, the jump-nerve anastomosis will be dissolved and the hypoglossal nerve relocated to its original position. As a next step, the cross-face-transfer will completed by a microsurgical suture of the healthy facial nerve to the damaged one. By doing so, the jump-nerve anastomosis, between the facial and hypoglossal nerve, is used only as a temporary “bridge-connection” until the necessary time period for nerve impulses from the healthy side of the face can reach and therefore be used from the paralysed side. The cross-face procedure provides the following advantages:
1.Synchronous innervation of the face through impulses of the opposite healthy side
2.Anatomic reconstruction, since the hypoglossal nerve is not primarily responsible for the movement of the mimic muscules.
3. Avoidance of involuntary movement of the face during tongue movements.