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.
LeeEI, HurvitzKA, EvansGRD, et al.Cross-facial nerve graft: Past and present. J Plast Reconstr Aesthet Surg. 2008; 61(3):250–256; doi: 10.1016/J.BJPS.2007.05.016
3.
ScaramellaLF. Anastomosis between the two facial nerves. Laryngoscope. 1975; 85(8):1359–1366; doi: 10.1288/00005537-197508000-00012
4.
AnderlH. Reconstruction of the face through cross-face-nerve transplantation in facial paralysis. Chir Plast. 1973; 2(1):17–45; doi: 10.1007/BF00280913/METRICS
5.
Snyder-WarwickAK, FattahAY, ZiveL, et al.The degree of facial movement following microvascular muscle transfer in pediatric facial reanimation depends on donor motor nerve axonal density. Plast Reconstr Surg. 2015; 135(2):370e–381e; doi: 10.1097/PRS.0000000000000860
TerzisJK, KarypidisD. Therapeutic strategies in post-facial paralysis synkinesis in pediatric patients. J Plast Reconstr Aesthet Surg. 2012; 65(8):1009–1018; doi: 10.1016/J.BJPS.2012.03.026
9.
TerzisJK, KarypidisD. The outcomes of dynamic procedures for blink restoration in pediatric facial paralysis. Plast Reconstr Surg. 2010; 125(2):629–644; doi: 10.1097/PRS.0B013E3181C91F69
10.
WeissJBW, SpuerckF, KollarB, et al.Age-related outcome of facial reanimation surgery using cross face nerve graft and gracilis free functional muscle transfer-A retrospective cohort study. Microsurgery. 2022; 42(6):557–567; doi: 10.1002/MICR.30896
11.
HeB, ZhuZW, ZhuQT, et al.Factors predicting sensory and motor recovery after the repair of upper limb peripheral nerve injuries. Neural Regen Res. 2014; 9(6):661–672; doi: 10.4103/1673-5374.130094
12.
DeviBI, KonarSK, BhatDI, et al.Predictors of Surgical Outcomes of Traumatic Peripheral Nerve Injuries in Children: An Institutional Experience. Pediatr Neurosurg. 2018; 53(2):94–99; doi: 10.1159/000484174
KehrerA, HollmannKS, KleinSM, et al.Histomorphometry of the sural nerve for use as a CFNG in facial reanimation procedures. J Clin Med. 2023; 12(14); doi: 10.3390/JCM12144627
15.
ParkSO, HaJH, KimIK, et al.Single-stage cross-facial nerve grafting has a result equivalent to that of two-stage cross-facial nerve grafting. Microsurgery. 2020; 40(2):175–182; doi: 10.1002/MICR.30448
16.
Urso-BaiardaF, GrobbelaarAO. A comparison of one- versus two-stage surgery in an experimental model of functional muscle transfer with interposed nerve grafting. J Plast Reconstr Aesthet Surg. 2009; 62(8):1042–1047; doi: 10.1016/J.BJPS.2008.01.008
17.
TerzisJK, KonofaosP. Experience with 60 adult patients with facial paralysis secondary to tumor extirpation. Plast Reconstr Surg. 2012; 130(1):51e–66e; doi: 10.1097/PRS.0B013E318254B149
18.
AronsonS, ApplebaumSA, KelseyLJ, et al.Evidence-based practices in facial reanimation surgery. Plast Reconstr Surg. 2023; 152(3):520e–533e; doi: 10.1097/PRS.0000000000010539
19.
HontanillaB, MarreD. Retrospective study of the functional recovery of men compared with that of women with long-term facial paralysis. Br J Oral Maxillofac Surg. 2013; 51(8):684–688; doi: 10.1016/J.BJOMS.2013.04.012
20.
FreyM, GiovanoliP, MichaelidouM. Functional upgrading of partially recovered facial palsy by cross-face nerve grafting with distal end-to-side neurorrhaphy. Plast Reconstr Surg. 2006; 117(2):597–608; doi: 10.1097/01.PRS.0000197136.56749.C6
21.
MorleySE. Combining an end to side nerve to masseter transfer with cross face nerve graft for functional upgrade in partial facial paralysis-an observational cohort study. J Plast Reconstr Aesthet Surg. 2021; 74(7):1446–1454; doi: 10.1016/J.BJPS.2020.11.015
22.
TerzisJK, TzafettaK. The “babysitter” procedure: Minihypoglossal to facial nerve transfer and cross-facial nerve grafting. Plast Reconstr Surg. 2009; 123(3):865–876; doi: 10.1097/PRS.0B013E31819BA4BB
MorleySE. Are dynamic procedures superior to static in treating the paralytic eyelid in facial paralysis? J Plast Reconstr Aesthet Surg. 2023; 77:8–17; doi: 10.1016/J.BJPS.2022.10.037
25.
HontanillaB, Olivas-MenayoJ, MarréD, et al.Maximizing the smile symmetry in facial paralysis reconstruction: An algorithm based on twenty years’ experience. Facial Plast Surg. 2021; 37(3):360–369; doi: 10.1055/S-0041-1722905
26.
LeongSC, LesserTH. Long-term outcomes of facial nerve function in irradiated and nonirradiated nerve grafts. Ann Otol Rhinol Laryngol. 2013; 122(11):695–700; doi: 10.1177/000348941312201106
27.
HontanillaB, OlivasJ, CabelloÁ, et al.Cross-face nerve Grafting versus Masseteric-to-facial nerve transposition for reanimation of incomplete facial paralysis: A comparative study using the FACIAL CLIMA evaluating system. Plast Reconstr Surg. 2018; 142(2):179E–191E; doi: 10.1097/PRS.0000000000004612
28.
Doud GalliSK, ValauriF, KomisarA. Facial reanimation by cross-facial nerve grafting: Report of five cases. Ear Nose Throat J. 2002; 81(1):25–29; doi: 10.1177/014556130208100109
TerzisJK, KarypidisD. Therapeutic strategies in post-facial paralysis synkinesis in adult patients. Plast Reconstr Surg. 2012; 129(6):925e–939e; doi: 10.1097/PRS.0B013E318230E758
31.
BanksCA, BhamaPK, ParkJ, et al.Clinician-graded electronic facial paralysis assessment: The eFACE. Plast Reconstr Surg. 2015; 136(2):223e–230e; doi: 10.1097/PRS.0000000000001447
32.
KimMG, BaeCR, OhTS, et al.Reliability and validity of emotrics in the assessment of facial palsy. J Pers Med. 2023; 13(7); doi: 10.3390/JPM13071135
33.
GaberA, TaherMF, WahedMA, et al.Comprehensive assessment of facial paralysis based on facial animation units. PLoS One. 2022; 17(12):e0277297; doi: 10.1371/JOURNAL.PONE.0277297
34.
BoonipatT, AsaadM, LinJ, et al.Using artificial intelligence to measure facial expression following facial reanimation surgery. Plast Reconstr Surg. 2020; 146(5):1147–1150; doi: 10.1097/PRS.0000000000007251
35.
KnoedlerL, MiragallM, Kauke-NavarroM, et al.A ready-to-use grading tool for facial palsy examiners-automated grading system in facial palsy patients made easy. J Pers Med. 2022; 12(10); doi: 10.3390/JPM12101739
36.
KehrerA, RueweM, da SilvaNPB, et al.Using high-resolution ultrasound to assess post-facial paralysis synkinesis-machine settings and technical aspects for facial surgeons. Diagnostics (Basel, Switzerland). 2022; 12(7); doi: 10.3390/DIAGNOSTICS12071650
CobbettR, PJ, AnderlH. FRCS Section of Plastic Surgery. 1976; 69.
40.
MayM. Management of cranial nerves I through VII following skull base surgery. Otolaryngol Head Neck Surg (1979). 1980; 88(5):560–575; doi: 10.1177/019459988008800509
DelbekeJ, ThauvoyC. Electrophysiological evaluation of cross-face nerve graft in treatment of facial palsy. Acta Neurochir (Wien). 1982; 65(1-2):111–127; doi: 10.1007/BF01405447
43.
Salimbeni-UghiG. Evaluation of results in 36 cases of facial palsy treated with nerve grafts. Ann Plast Surg. 1982; 9(1):36–41; doi: 10.1097/00000637-198207000-00008
44.
Gary-BoboA, FuentesJM. Long-term follow-up report on cross-facial nerve grafting in the treatment of facial paralysis. Br J Plast Surg. 1983; 36(1):48–50; doi: 10.1016/0007-1226(83)90009-7
45.
RaymentR, PooleMD, RushworthG. Cross-facial nerve transplants: Why are spontaneous smiles not restored? Br J Plast Surg. 1987; 40(6):592–597; doi: 10.1016/0007-1226(87)90153-6
46.
van VeenMM, DijkstraPU, WerkerPMN. A higher quality of life with cross-face-nerve-grafting as an adjunct to a hypoglossal-facial nerve jump graft in facial palsy treatment. J Plast Reconstr Aesthet Surg. 2017; 70(11):1666–1674; doi: 10.1016/J.BJPS.2017.06.002
47.
SergesketterAR, ShammasRL, MassaLA, et al.Early simultaneous cross facial nerve graft and masseteric nerve transfer for facial paralysis after tumor resection. Plast Reconstr Surg Glob Open. 2023; 11(3):E4869; doi: 10.1097/GOX.0000000000004869
48.
ZhangB, YangC, WangW, et al.Repair of ocular-oral synkinesis of postfacial paralysis using cross-facial nerve grafting. J Reconstr Microsurg. 2010; 26(6):375–380; doi: 10.1055/S-0030-1249603
49.
Kaufman GoldbergT, TrzcinskiLO, McGonagleER, et al.Does supercharging with cross-face nerve graft enhance smile in non-flaccid facial paralysis patients undergoing selective neurectomy? Microsurgery. 2023; 44(1):e31118; doi: 10.1002/MICR.31118
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