Cross-Face Nerve Grafting for Reanimation of Incomplete Facial Paralysis: Quantitative Outcomes Using the FACIAL CLIMA System and Patient Satisfaction

Abstract

Although in most cases Bell palsy resolves spontaneously, approximately one-third of patients will present sequela including facial synkinesis and paresis. Currently, the techniques available for reanimation of these patients include hypoglossal nerve transposition, free muscle transfer, and cross-face nerve grafting (CFNG). Between December 2008 and March 2012, eight patients with incomplete unilateral facial paralysis were reanimated with two-stage CFNG. Gender, age at surgery, etiology of paralysis denervation time, donor and recipient nerves, presence of facial synkinesis, and follow-up were registered. Commissural excursion and velocity and patient satisfaction were evaluated with the FACIAL CLIMA and a questionnaire, respectively. Mean age at surgery was 33.8 ± 11.5 years; mean time of denervation was 96.6 ± 109.8 months. No complications requiring surgery were registered. Follow-up period ranged from 7 to 33 months with a mean of 19 ± 9.7 months. FACIAL CLIMA showed improvement of both commissural excursion and velocity greater than 75% in 4 patients, greater than 50% in 2 patients, and less than 50% in the remaining two patients. Qualitative evaluation revealed a high grade of satisfaction in six patients (75%). Two-stage CFNG is a reliable technique for reanimation of incomplete facial paralysis with a high grade of patient satisfaction.

Keywords

incomplete facial paralysis - cross-face nerve graft - FACIAL CLIMA

• References

• 1 Gilden DH. Clinical practice. Bell's Palsy. N Engl J Med 2004; 351 (13) 1323-1331
• 2 Yamamoto Y, Sekido M, Furukawa H, Oyama A, Tsutsumida A, Sasaki S. Surgical rehabilitation of reversible facial palsy: facial—hypoglossal network system based on neural signal augmentation/neural supercharge concept. J Plast Reconstr Aesthet Surg 2007; 60 (3) 223-231
• 3 Furukawa H, Saito A, Mol W, Sekido M, Sasaki S, Yamamoto Y. Double innervation occurs in the facial mimetic muscles after facial-hypoglossal end-to-side neural repair: rat model for neural supercharge concept. J Plast Reconstr Aesthet Surg 2008; 61 (3) 257-264
• 4 Terzis JK, Wang W, Zhao Y. Effect of axonal load on the functional and aesthetic outcomes of the cross-facial nerve graft procedure for facial reanimation. Plast Reconstr Surg 2009; 124 (5) 1499-1512
• 5 Terzis JK, Karypidis D. Therapeutic strategies in post-facial paralysis synkinesis in adult patients. Plast Reconstr Surg 2012; 129 (6) 925e-939e
• 6 Frey M, Giovanoli P, Michaelidou M. 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
• 7 Takushima A, Harii K, Okazaki M, Ohura N, Asato H. Availability of latissimus dorsi minigraft in smile reconstruction for incomplete facial paralysis: quantitative assessment based on the optical flow method. Plast Reconstr Surg 2009; 123 (4) 1198-1208
• 8 Scaramella LF, Tobias E. Facial nerve anastomosis. Laryngoscope 1973; 83 (11) 1834-1840
• 9 Anderl H. Cross-face nerve transplant. Clin Plast Surg 1979; 6 (3) 433-449
• 10 House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93 (2) 146-147
• 11 Linstrom CJ, Silverman CA, Susman WM. Facial-motion analysis with a video and computer system: a preliminary report. Am J Otol 2000; 21 (1) 123-129
• 12 Sargent EW, Fadhli OA, Cohen RS. Measurement of facial movement with computer software. Arch Otolaryngol Head Neck Surg 1998; 124 (3) 313-318
• 13 Meier-Gallati V, Scriba H, Fisch U. Objective scaling of facial nerve function based on area analysis (OSCAR). Otolaryngol Head Neck Surg 1998; 118 (4) 545-550
• 14 Hontanilla B, Aubá C. Automatic three-dimensional quantitative analysis for evaluation of facial movement. J Plast Reconstr Aesthet Surg 2008; 61 (1) 18-30
• 15 Hontanilla B, Vila A. Comparison of hemihypoglossal-facial nerve transposition with a cross-facial nerve graft and muscle transplant for the rehabilitation of facial paralysis using the facial clima method. J Plast Surg Hand Surg 2012; 46 (1) 25-31
• 16 Hontanilla B, Marré D. Comparison of hemihypoglossal nerve versus masseteric nerve transpositions in the rehabilitation of short-term facial paralysis using the Facial Clima evaluating system. Plast Reconstr Surg 2012; 130 (5) 662e-672e
• 17 Bulstrode NW, Harrison DH. The phenomenon of the late recovered Bell's palsy: treatment options to improve facial symmetry. Plast Reconstr Surg 2005; 115 (6) 1466-1471
• 18 Peitersen E. Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl 2002; (549) 4-30
• 19 Furukawa H, Saito A, Mol W, Sekido M, Sasaki S, Yamamoto Y. Double innervation occurs in the facial mimetic muscles after facial-hypoglossal end-to-side neural repair: rat model for neural supercharge concept. J Plast Reconstr Aesthet Surg 2008; 61 (3) 257-264
• 20 Koshima I, Nanba Y, Tsutsui T, Takahashi Y, Itoh S. New one-stage nerve pedicle grafting technique using the great auricular nerve for reconstruction of facial nerve defects. J Reconstr Microsurg 2004; 20 (5) 357-361
• 21 Lee EI, Hurvitz KA, Evans GR, Wirth GA. Cross-facial nerve graft: past and present. J Plast Reconstr Aesthet Surg 2008; 61 (3) 250-256