Nerve Transfers in Facial Palsy

Abstract

The facial paralysis patient suffers serious functional, cosmetic, and psychological problems with impaired ability to communicate. Despite the advances of recent years and the number of new techniques proposed in the literature, facial reanimation remains a challenge for the reconstructive surgeon. With the advent of microsurgery, reanimation of the paralyzed face took a major leap forward with the use of cross facial nerve grafts, nerve transfers, and free muscle transplantation. Today, nerve transfers represent the backbone of facial reanimation, especially in cases where reconstruction of the affected facial nerve is not feasible. The suitability of each nerve transfer is related to the type of facial palsy, time elapsed since injury, and the age and general health of the patient. The selected motor nerve must provide strong muscle contraction and allow the patient to control the facial movements. The purpose of this chapter is to present the senior author's (J.K.T.) experience in the selection of motor nerves that can function as possible donor nerves for dynamic facial reanimation. Indications and surgical technique for each procedure is also presented.

The Outcomes of Dynamic Procedures for Blink Restoration in Pediatric Facial Paralysis

“…Surgical techniques and postoperative care and rehabilitation have been described in detail by the senior author in previous publications. 11,18,19 …”

Local delivery of glial cell line–derived neurotrophic factor improves facial nerve regeneration after late repair

“…8 The results, however, have been disappointing due to the insufficient number and the immaturity of the regenerating nerve fibers, associated with the small amount of fibers available in the donor site and the length of the nerve gap. 9 For these reasons, cross-facial nerve grafting is nowadays only used in combination with other techniques such as hypoglossal-facial anastomosis (babysitter procedure), 10,11 or free muscle transfer (m. gracilis, m. pectoralis minor, etc.). 12 All surgical techniques described above have largely contributed to reanimate a paralyzed face, yet with inconsistent results related to the anatomical and individual variability.…”

Masseteric–facial nerve anastomosis for early facial reanimation

“…The motor roots of the cervical plexus are an alternative but less favourable motor source, indicated only when complex multiple cranial nerve involvement is present (Terzis and Konofaos, 2008).…”