CPT® Code 64868

1. Indications

The facial-hypoglossal anastomosis procedure (CPT® Code 64868) is indicated for patients experiencing facial nerve dysfunction due to various conditions. These may include:

• Facial Nerve Injury: Trauma or surgical interventions that have resulted in damage to the facial nerve, leading to loss of facial muscle function.
• Facial Nerve Tumors: Neoplasms affecting the facial nerve that necessitate surgical intervention and subsequent reconstruction.
• Congenital Facial Nerve Disorders: Conditions present at birth that affect the development and function of the facial nerve.

2. Procedure

The surgical procedure for facial-hypoglossal anastomosis involves several critical steps to ensure successful nerve reconstruction. Each step is performed with precision to facilitate optimal outcomes.

• Step 1: An incision is made just in front of the auricle of the ear, extending around the ear lobe and along the mandible. This incision allows access to the underlying structures necessary for the procedure.
• Step 2: A skin flap is elevated to expose the parotid gland. The inferior aspect of the parotid gland is carefully dissected off the sternocleidomastoid muscle to provide a clear view of the facial nerve.
• Step 3: Dissection continues to the digastric muscle, where the tissue anterior to the tip and superior to the tragus is meticulously dissected to identify the facial nerve as it exits the stylomastoid foramen.
• Step 4: The facial nerve is dissected to the point of injury or damage and is transected distal to this point to prepare for anastomosis.
• Step 5: The hypoglossal nerve is located by following the digastric muscle belly toward the hyoid bone. Distal dissection of the hypoglossal nerve is performed until sufficient length is achieved for the anastomosis.
• Step 6: The hypoglossal nerve is transected distally and transposed to align with the healthy distal segment of the facial nerve.
• Step 7: Finally, the nerve ends are anastomosed using a perineural or epineural technique, ensuring a secure connection that promotes nerve regeneration.

3. Post-Procedure

After the facial-hypoglossal anastomosis procedure, patients typically require careful monitoring and follow-up care. Post-operative care may include pain management, wound care, and physical therapy to facilitate recovery and improve facial function. Patients are advised to avoid strenuous activities during the initial healing phase. The expected recovery period can vary, with gradual improvement in facial movement as the nerves regenerate. Regular follow-up appointments are essential to assess the healing process and the effectiveness of the nerve reconstruction.