Cross-Facial Nerve Grafting for Facial Reanimation

Peng, Grace Lee MD
Azizzadeh, Babak MD, FACS

¹Department of Otolaryngology—Head and Neck Surgery, University of California, Los Angeles, California
²Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, Keck School of Medicine at the University of Southern California, California
³Center for Advanced Facial Plastic Surgery, Beverly Hills, California

Address for correspondence Babak Azizzadeh, MD, FACS, Center for Advanced Facial Plastic Surgery, Beverly Hills, CA, [email protected]

Facial Plastic Surgery 31(2):p 128-133, April 2015. | DOI: 10.1055/s-0035-1549046

Abstract

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. The nerve can be harvested using a small incision, which leaves the patient with minimal post operative morbidity. In this chapter, we highlight the pearls and pitfalls of cross facial nerve grafting.