Combination of hypoglossal-facial nerve anastomosis and botulinum-toxin injections to optimize mimic rehabilitation after removal of acoustic neurinomas

This report refers to 10 patients treated with hypoglossal-facial nerve anastomosis and botulinum-toxin type A after removal of acoustic neurinomas. All patients who underwent this regimen showed reinnervation of mimic muscles after nerve anastomosis in all parts of the mimic musculature. Synkinesis could be observed in all patients. Botulinum-toxin injections into the orbicularis oculi muscle improved the functional outcome, leading to an approximation of the palpebral fissure width to the healthy side during heterogenous face movements. The mean duration of the toxin effect was 13.8 weeks. Side effects were rare. It can be stated that the combination of hypoglossal-facial nerve anastomosis and botulinum-toxin injections is suited to optimize mimic rehabilitation after removal of acoustic neurinomas.