Jump Graft

[Dils]

Hi,
I am a 39 y.o female.  I had a 2 cm AN removed 6 weeks ago.  Unfortunately, my facial nerve was cut during surgery.  Now I have facial palsy on my left.  My Neuro and ENT recommend 12/7 jump graft.  I have a 4.5 year old son with autism.  I am concerned whether I will have speech issues after the jump graft.  I am not sure what to expect with the jump graft.  Please help!!!!

[ToddH]

Hi, a "jump graft" means that they will be doing a nerve graft from the XIIth cranial nerve (CN), the hypoglossal n., that is motor to your tongue (allows you to move it; nothing to do with taste or tongue sensation) to branch(s) of your paralyzed VIIth CN, the facial nerve. They used to use the whole XIIth CN in the grafting, but discovered 3 things about it that were bad: 1) the XIIth CN is much larger than the VIIth, so it supplied way too much power to the face, 2) that excess power tended to lead to a lot of mass-action synkinesis, and 3) because the tongue lost all its power on that side, it atrophied on 1 side and caused difficulty moving food, swallowing properly, and speech problems. Some people adapted to this, but many/most did not. Soooo, Mark May, MD here in Pittsburgh developed the XII-VII jump graft, which is essentially a split graft that only takes a portion of the XIIth CN to graft to the VIIth and it works by providing proper amount of power to the face and not causing the tongue to become real weak (a little maybe, yes, but usually fine).  Also, much less, if any, synkinesis
Therefore, the research has shown these people do not have speech or swallowing problems, or if so, very minor. The last person I saw who had a jump graft done had no tongue weakness, and no functional problems at all! Their speech was perfect.
As always, it is important that you have it done by a surgeon who has experience doing it... you don't want to be their 1st of 2nd try...
Also, be aware that you will likely have to press your tongue against either your palate or back of front teeth to make your face contract, at least for the 1st year or 3, until your brain can "integrate" it.  Also, there will be a 6-12 month post-surgical "wait" period for the nerve to regenerate through the graft (that is true for ANY nerve graft surgery, by the way = no instant gratification). The beauty of it is that it can provide a lot of tone & movement in an otherwise paralysed face!
It would be great if anyone on this Forum who has had it done can provide their input and experience!
Good luck  and hope this helps in your decision-making.
Todd - PT

[Kaybo]

Dils-
I had this done and do not have speech problems - I'll write more later when i get the kids to school!

K   

[leapyrtwins]

Dils -

Lori (lori67) had the 7/12 jump surgery last October.  I'm sure she'll chime in at some point with her experience.

Good luck,

Jan

[saralynn143]

Todd, thanks for the great explanation. I'd just like to add that the 6-12 month wait is also true for those of us whose facial nerve was severely stretched or otherwise injured during surgery.

Dils if you do a google search on "facial reanimation surgery" you will find information about the 7/12 jump and other surgeries as well as before and after pictures. I know I felt a lot better once I saw the possibilities out there, fortunately my nerve is regenerating by itself.

Are you having speech problems now? I had quite a bit of trouble with Ps, Bs and Fs right after surgery, but that improved even before I got any facial movement back. A couple of months out my son's speech therapist even told me my speech sounded great.

Best wishes for a successful surgery.

Sara

[moe]

Hi Dils,
I had the jump graft here in WA state, with partial results, probably because it was done 18 months post AN surgery. The face nerve was cut and directly reanastomosed during the original surgery.
I could probably have had the jump much sooner, but geographical military separation with hubby made it impossible to have more surgery until the 18 month mark.
Anyway, they took a portion of the hypoglossal nerve, connected to the face nerve.

I had no deficits, at all.Tongue movement perfect, no speech deficit. Got some movement and facial tone, but not enough.
The pushing the tongue on your palate or teeth thingy did not help with movement along the cheek, upper lip, unfortunately.
I regained movement on the lower mouth lip, which was weird because the doc said you will gain movement on the top first. My nerves are a little confused.

You should have GREAT results, since it will be done 6 months post op. Lori had good results with hers. Plan on another wait and see healing time. I know it sucks, so frustrating.
After 4 years of my facial paralysis and 2 surgeries to jump the face nerve,I'm finally getting my "smile" surgery this May! Yea!

Good luck with your surgery. The surgery itself is a piece of cake, compared to brain surgery. Took about 7 hours. Had a drain in the neck which was taken out the next day, and I was sent home! Incision under the jaw bone along the neck which is covered by hair. It healed nicely.
Cheers,
Maureen

[lori67]

Hi all!

I had the 7/12 done a year ago last October and have no real speech problems.  Yes, there is some residual tongue weakness and loss of taste and sensation on that side, but very minor.  The first few days after the surgery, my speech was awful - sounded like I had marbles in my mouth, but after a few days the swelling went down and it was much better.  When I get tired, I do have some trouble really enunciating, but apparently, I'm the only one who notices.

There is a bit of adjustment required - you need to learn the rewiring, like Todd mentioned.  To get the corner of my mouth to move upward into a smile requires me to put my tongue up the roof of my mouth.  This seems odd at first, but after a while, it just becomes second nature and you don't think about it, you just do it automatically.  I had movement at about 3 months after my surgery - not a lot, but that's when it started.  I'm still getting new movements even this long post-op and I anticipate that will continue for a few years.  I can close my eye almost all the way, and my blink is improving.  My symmetry at rest is very good.

My surgery took about 4-5 hours.  Not really sure - I was asleep!     Spent one night in the hospital and really never had any pain that couldn't be managed with tylenol.  I did have to eat soft foods like mashed potatoes, oatmeal, ice cream, etc. for a week or so.

I had good results and I would do it again.  It really has made a big improvement.

Lori

[Dils]

Thank you all for giving me such valuable information. I feel a lot more confident about the jump graft now. 

I had swallowing issues but it improved within 1 - 2 weeks.  I have no real speech problems..........although pronouncing words with F & P is a bit difficult as my left cheek fills with air Now I keep a finger on my cheek before I say anything beginning with F & P. I can close about 60% of my left eye but doc said to leave the gold weight option until the jump graft is done and see how it goes.  I am 7 weeks post -op now and hopefully the jump graft will be done within the next month or so.

My doc said I may not get blink back but eye closure is possible.  I was happy to hear that Lori has some blink.  Who performs this surgery......ENT or Neuro?  My ENT is planning on doing this surgery  (he is also a head and neck surgeon) without a neuro involved.  Does this surgery give you symmetry when you talk and smile too or is it only at rest?

THANK YOU all once again for your response.  I really appreciate it.  I am so glad I can ask someone what it is really like rather than keep thinking and driving myself nuts. 

[moe]

The surgeon who performed my jump graft was a neurotologist, same one who performs AN surgery. But it was not the same neurotologist who did my original AN surgery, as he did not have much experience with them.
Does that make any sense?
Maureen

[lori67]

I had mine done by the same neurotologist that did my AN surgery.

The symmetry I have is just at rest.  My lower lip on the AN side does not have any movement, but I believe that is due to tightness in the muscles in my chin, which is the next issue we are planning to address.  I can only do a closed-mouth smile and it is not symmetrical at this point, but another one of those things that I think will improve with time and with controlling the muscle tightness in my chin.  After a while, you begin to figure out how to make things move the way you want them and you learn to figure out what is inhibiting or limiting your movement.  You'll spend a lot of time making faces at yourself in the mirror!   

I think leaving the eye weight in until after the surgery is a good idea.  Unfortunately, you'll go back to ground zero with movement for a little while, so it's best to keep that eye protected as much as possible.  Then when you start to get some movement back, you can always look into having the weight removed.

Dils, no reason to drive yourself nuts - we'll do it for you!   
Lori

[ToddH]

Just to add, a "neurotologist" is an ENT who has specialized even more as a head and neck surgeon. A "neurosurgeon" is a specialist in their own right, a brain surgeon, if you will. Often the 2 will work together in AN surgery, performing different tasks.
Todd - PT

[Dils]

Thank you all.......you have no idea how much appreciate your comments

I was also wondering whether I will be able to show any emotion from the eye on the paralized side.  It looks pretty dead now.  My eye was huge soon after surgery but it has gone back to its normal size and I've got a very slight blink.

Other than improving tone and symmetry, what will this jump graft give me? From what I've read so far on the internet, there will be more "procedures" to improve/enhance different areas of my face (by this I dont mean lips like Angelina Joli!) even after the jump graft.  I will be happy if I can move my lips on the left when I speak and have a normal smile.  At the moment I dont have facial droop........should I expect this to happen too?

I look at my face everyday and come up with new questions

[Kaybo]

Dils~
I don't have any tears on my AN side - at least not that flow down my face.  I have one every so occasionally, but never when I am crying - just kind of random.  I had the 12/7 done 13 years ago - I think that it is MUCH improved since then.  I did get a little movement, but more than anything, it was hooked back up to a "live wire" so it got tone back and didn't look so dead anymore.  I then went on to have the T3 in 2008 and have been really pleased with the results - still not perfect, but great for what I went from!     Incidentally, everyone said I DID have Angelina Jolie lips for a while there (they took tendon from my leg and placed it in my lips), but alas, as all good things...it has come to an end!   

K   

[leapyrtwins]

A neurosurgeon is much more than a "brain surgeon".  A neurosurgeon is a highly trained specialist doctor who has a primary focus of addressing conditions affecting the peripheral nerves and the main nervous system. In other words, this type of doctor will work on areas of the body that include the brain, the spine, potentially the arteries in the neck, and the nerves in the body.

Neurotologists are specially-trained ear surgeons. They provide medical and surgical care for newborns to adults with diseases and conditions that affect the ears, hearing, balance system, facial nerve, temporal bone, skull base and related structures of the head and neck.

Copped these definitions from a web search 

Jan

[moe]

Jan,
Wow, I would have been REALLY impressed if you came up with that definition on your own!
 I was thinking more of " The neurosurgeon drills or opens up the skull , the neurotologist takes out the tumor, the neurosurgeon puts the skull back. "

One other thing with the 12/7. I have a little bit of residual numbness to the lower ear lobe, just as the doctor predicted. The side of the face remained kind of numb for months also.

A wait and see with the results. Hopefully more muscle tone  AND movement, especially around the eye. I would bet you are going to have good results since the surgery is so soon post AN surgery.
Our affected side will never be perfect unfortunately, but hopefully we can accept what we are given
(I'm still working on that!)
Maureen