Hypoglossal to Facial

• Also used spinal accessory and phrenic

• Leads to paralysis of ipsilateral tongue

• Use modified parotidectomy incision

• Identify facial nerve, follow it to the pes, and divide it at the stylomastoid foramen

• Identify hypoglossal nerve and trace anteriorly

• Freshen ends and suture

• Return of function begins in 4-6 months, all have some degree of synkinesis

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