Comparison of hypoglossal nerve transfer and hypoglossal jump nerve graft techniques for facial reanimation: A systematic review

Background

Facial paralysis significantly affects patient quality of life by impairing facial expression, speech, and swallowing. Hypoglossal nerve transfer (HNT) and hypoglossal jump nerve graft (HJG) are established surgical techniques for facial reanimation, each with distinct advantages and complications. This systematic review compares the functional outcomes and complications of HNT and HJG to guide optimal surgical decision making.

Methods

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was conducted across 7 databases. Studies comparing HNT (end-to-end [ETE] or end-to-side [ETS]) and HJG techniques in adults with facial paralysis were included. Primary outcomes included facial movement recovery assessed via the House-Brackmann (HB) scale, Sunnybrook grading system, FaCE survey, or Facial Disability Index. Secondary outcomes included complication rates, quality of life, and predictors of surgical success. Risk of bias was assessed using ROB-2, Newcastle-Ottawa Scale, and ROBINS-I tools.

Results

A total of 34 studies comprising 1008 patients were included. HNT (ETE) provided robust facial reanimation but was associated with high rates of tongue atrophy (73%) and speech/swallowing difficulties (57%). HNT (ETS) preserved partial hypoglossal function and reduced morbidity while maintaining favorable outcomes (HB II–III recovery in 78–86%). HJG minimized complications, with no severe tongue atrophy and HB II–III recovery in 62.5–91.6% of patients. Recovery was slower in patients who underwent HJG due to nerve grafting but resulted in improved long-term facial symmetry and reduced synkinesis.

Conclusion

Both HNT and HJG are effective for facial reanimation. HNT (ETE) offers faster recovery but has higher morbidity, while HJG minimizes complications and maintains functional outcomes. HNT (ETS) provides a balance between efficacy and morbidity. Future comparative studies using standardized outcome measures are needed to refine patient-specific surgical selection, guided by accumulated clinical experience and published outcomes.