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Hypoglossal nerve transfer in obstetric brachial plexus palsy.

Gerhard Blaauw1, Ymte Sauter, Cyrielle L E Lacroix

  • 1Department of Neurosurgery, University Hospital Maastricht, 6202 AZ Maastricht, The Netherlands. gerhard.blaauw@planet.nl

Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS
|April 25, 2006
PubMed
Summary

Hypoglossal nerve transfer for obstetric brachial plexus palsy showed significant donor site morbidity, including oral problems and associated movements. The functional arm recovery did not outweigh the loss of hypoglossal nerve function.

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Area of Science:

  • Neurosurgery
  • Pediatric Orthopedics
  • Reconstructive Surgery

Background:

  • Obstetric brachial plexus palsy (OBPP) can lead to significant upper limb dysfunction.
  • Hypoglossal nerve transfer is a reconstructive option for OBPP, aiming to restore arm function.
  • Evaluating donor site morbidity and functional recovery is crucial for assessing treatment efficacy.

Purpose of the Study:

  • To conduct a cost-benefit analysis of hypoglossal nerve transfer in children with OBPP.
  • To assess both functional arm recovery and donor site morbidity following the procedure.
  • To determine if the functional gains justify the sacrifice of hypoglossal nerve function.

Main Methods:

  • A cohort of six patients with OBPP underwent hypoglossal nerve transfer.

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  • Functional arm outcomes were evaluated using the Mallet scale and physical examination.
  • Late donor site morbidity was assessed by speech therapists analyzing oral and communicative functions.

    • Main Results:

    • Early donor site morbidity caused parental anxiety.
    • Late donor site morbidity included significant oral problems and associated movements during mouth/tongue activity.
    • Successful recovery of powerful volitional elbow flexion was achieved in only four out of six patients.

    Conclusions:

    • The functional benefits of hypoglossal nerve transfer in this series did not appear to justify the sacrifice of hypoglossal nerve function.
    • Significant early and late donor site morbidity raises concerns about this surgical approach for OBPP.
    • Further research is needed to explore alternative or refined reconstructive strategies for OBPP.