49. Assessing the Benefit of Adding Cross-facial Nerve Grafts to a Masseteric to Facial Nerve Transfer for Smile and Periorbital Reanimation in Subacute Facial Palsy

Abstract

PURPOSE: Comparing long-term outcomes of nerve to masseter (NTM) to facial nerve (FN) transfer with and without cross-facial nerve graft (CFNG). METHODS: Patients with subacute facial palsy who received a NTM to FN transfer with or without a CFNG from 2013-2020 were reviewed. One year minimal follow up was required. Outcomes measures based on professional standardized photos of patients in repose, closed, and open smile were analyzed pre-operatively, at 3-months, 1-year, 3-years, and 5-years postoperatively as available. Emotrics software (Massachusetts Eye and Ear Infirmary, Boston, MA) and ImageJ (Rasband, W.S., ImageJ, U.S, National Institutes of Health, Bethesda, MD) were used for all measurements. Between group and within group longitudinal comparisons at each timepoint were analyzed using Wilcoxon Two-Sample Testing. RESULTS: Preoperative midface smile parameters were similar between groups (NTM=7, NTM+CFNG=17). At one-year (NTM=6, NTM+CFNG=17), closed mouth smile modiolus angle in NTM+CFNG was increased (NTM=96.135 degrees, NTM+CFNG=105.953 degrees, p=0.019). At 3-year (NTM=4, NTM+CFNG=16), open mouth modiolus angle in NTM+CFNG was increased (NTM=102.929mm, NTM+CFNG=115.269mm, p=0.0206). Midface smile parameters were similar between the groups at 5-year follow up. Preoperative periorbital symmetry measurements in repose were similar between groups. At one-year, marginal reflex distance 1 in NTM+CFNG was decreased (NTM=1.312mm, NTM+CFNG=0.587mm, p=0.025). At three-year, there were significant differences in marginal reflex distance 1 (NTM=1.728mm, NTM+CFNG=0.417mm, p=0.0264) and marginal reflex distance 2 (NTM=0.603mm, NTM+CFNG=0.632mm, p=0.0071). Symmetry measurements were similar at the 5-year point. CONCLUSION: There was long-term improvement in resting periorbital symmetry with the addition of a CFNG. Midface smile showed no consistent long-term improvement.