Contemporary techniques for nerve transfer in facial reanimation

William Dougherty,Myriam Loyo,Robert Liebman

doi:10.20517/2347-9264.2020.195

William Dougherty, Myriam Loyo + Show 1 more

Open Access

https://doi.org/10.20517/2347-9264.2020.195

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Abstract

Nerve transfer procedures have the potential to restore innervation and function to the native facial musculature. This review summarizes the existing literature on facial nerve injury, regeneration, and reinnervation techniques with a focus on nerve transfer and its various options. Utilizing nerve transfer as early as possible, and ideally during the first 12 months of paralysis, is recommended. Prolonged paralysis is frequently not amenable to nerve transfer. The masseteric nerve provides excellent smile restoration after coapation to midfacial nerve branches with minimal morbidity. Several modifications to the hypoglossal nerve transfer have been described to limit its morbidity in speech and swallowing. The cross facial nerve, while appealing and able to achieve a true spontaneous smile, has limitations in terms of axonal load, time to reinnervation, unpredictable outcomes, and utility in older patients, who have less regenerative potential. Finally, there are exciting new developments in the field, combining reanimation techniques to harness advantages of various donor nerves, and research in peripheral nerve regeneration.

Highlights

Facial paralysis has considerable functional and psychological morbidity[1]
This review is focused on understanding nerve transfer procedures for facial reanimation
In addition to the previously described techniques, the hypoglossal nerve may be used as a “baby-sitting” procedure in combination with a cross facial nerve graft to maintain innervation to the facial musculature while awaiting for cross facial nerve axonal growth; this is further discussed in the section of combined nerve transfers later in the review

Summary

Introduction

Facial paralysis has considerable functional and psychological morbidity[1]. Facial nerve anatomy and physiology is among the most complex in the human body. Many contemporary techniques utilize concurrent nerve transfer with cable grafting in an effort to improve outcomes from immediate repair of sacrificed facial nerves. In addition to the previously described techniques, the hypoglossal nerve may be used as a “baby-sitting” procedure in combination with a cross facial nerve graft to maintain innervation to the facial musculature while awaiting for cross facial nerve axonal growth; this is further discussed in the section of combined nerve transfers later in the review.

Results

Conclusion