Long-term follow-up report on cross-facial nerve grafting in the treatment of facial paralysis

Cross-Facial Nerve Grafting Used Independently in Facial Reanimation: A Narrative Review

Importance: Cross-Facial Nerve Grafting (CFNG) for facial palsy offers potential to restore spontaneous facial expression, but specific indications and associated outcomes are limited. Updates to this technique have aided in its successful employment in select cases. This review aims to explore the context in which CFNG has been successfully utilized as a primary modality. Observations: Literature review was performed auditing all studies investigating CFNG as a primary modality, which reported outcomes. A total of 326 cases reporting outcomes for primary CFNG were included. Eye closure outcomes were 83.3% successful at ages 0-18, 77.3% successful at ages 19-40, and 57.1% successful at ages 41+. Smile outcomes were 73.7% successful at ages 0-18, 81.5% successful at ages 19-40, and 52.8% successful at ages 41+. For synkinesis, 89% of cases were considered successful; 100% successful at ages 0-18, and 78.4% successful in adults. Conclusions and Relevance: CFNG may offer return of spontaneous facial function in select cases. Higher percentages of successful outcomes are observed in younger patients, when performed in two stages, and when performed earlier from the onset of FP in cases of eye closure restoration. In the modern era, CFNG has been more commonly employed as an adjunctive procedure to other reanimation techniques.

Facial reinnervation after facial paralysis: is it ever too late?

Following Conley's work on facial nerve cross-over surgery in long-standing facial paralysis, we have reviewed five cases of paralysis of 2.5-7 years' duration. All had complete absence of electrical activity on preoperative EMG and ENG studies. In four of the five cases the facial nerve was not severely atrophic and a "cross-over" technique was feasible. Post-operatively, the results were electrically and clinically good to excellent. To foresee the results of facial nerve cross-over surgery, we have found that the degree of atrophy of the affected nerve at the time of reconstructive surgery is a more important factor than the time lapse since the beginning of the paralysis. Those results also seem better in younger patients. Our findings suggest that hypoglossal-facial cross-overs be considered even 3 years after a paralysis, mostly in younger patients, when the nerve is not severely atrophic. In some cases this technique can be complemented by muscular transfers or selected cosmetic surgery.

Preliminary observations after facial rehabilitation with the ansa hypoglossi pedicle transfer

Facial paralysis is a very disabling condition, both functionally and cosmetically. Despite the different methods of facial reanimation that have been described, there is no single method that will restore normal facial tone and motion. Of the methods available, primary neurorrhaphy is probably the most effective. The recovery period, however, is prolonged and, as a result, muscle tone and bulk may be lost. The hypoglossal-facial anastomosis is also a very reliable and effective technique but requires necessary interruption of both major cranial nerve trunks. Transfer of a neuromuscular pedicle (based on the ansa hypoglossi) has been offered as a method of facial reanimation that involves neither prolonged recovery nor interruption of the major cranial nerve functions. The application of this technique for reinnervation of a paralyzed larynx was first described by Tucker in 1970, and the technique was applied to facial muscle (in animal models) in 1977. The effectiveness of this technique--and its application in the management of facial paralysis in the human patient--remains controversial. We report our experience with a series of six patients who underwent neuromuscular pedicle transfer in conjunction with other more conventional methods of facial reanimation. The function of the pedicle and its contribution to the overall facial rehabilitation were assessed clinically and electromyographically. Factors influencing the success of the procedure and clinical and experimental evidence to support its application are discussed. While our experience with this technique is limited, it would appear that the neuromuscular pedicle transfer may play a useful adjunctive role in reanimation of the face in selective cases of facial paralysis.