Facial nerve graft

The cross-face nerve graft is a technique used in facial paralysis surgery to bring in nerve stimulation from the non-paralyzed to the paralyzed side of the face. It is similar tothe concept of an extension cord. It involves obtaining a nerve graft, most commonly from the lower leg, and implanting it into the non-paralyzed part of the face. The nerve graft is then connected to working branches of the facial nerve and tunneled to the paralyzed side of the face for innervation. It is used in one of two ways.

Once the healing process is complete, nerve signals will flow from the undamaged facial nerve across the graft into the previously paralyzed facial muscles producing movement. The nerve graft functions much like a telephone line delivering communication signals for the facial muscles. The ability to produce spontaneous, emotionally mediated movement is the greatest benefit of this technique. Before Surgery Video segment: Complete left facial paralysis after excision of facial nerve schwannoma with loss of eye closure and protective blinking.

Dynamic facial reanimation is the gold standard treatment for a paralyzed face. Over the last century, multiple nerves have been utilized for grafting to the facial nerve in an attempt to produce improved movement. However, in recent years, the use of cross facial nerve grafting with a second stage gracilis free flap has gained popularity due to the ability to generate a spontaneous smile and facial movement. Preoperative history taking and careful examination, as well as pre-surgical planning, are imperative to whether cross facial nerve grafting with a second stage gracilis free flap is appropriate for the patient. A sural nerve graft is ideal given the accessibility of the nerve, the length, as well as the reliability and ease of the nerve harvest.

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