A higher quality of life with cross-face-nerve-grafting as an adjunct to a hypoglossal-facial jump graft in facial palsy treatment.

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2017
• Main Authors: van Veen, Martinus M., BSc, Dijkstra, Pieter U., PT PhD, Werker, Paul M.N., MD PhD
• Format: Article
• Language: English
• Subjects: Plastic Surgery
• ISSN: 1748-6815
• DOI: 10.1016/j.bjps.2017.06.002

Summary Nerve reconstructions are the preferred technique for short standing facial paralysis, most commonly using the contralateral facial nerve or ipsilateral hypoglossal nerve. The hypoglossal nerve gives a strong motor signal. The signal of a cross-face nerve graft is weaker, but spontaneous. Spontaneity in facial expression is believed to be of importance for psychological wellbeing. Therefore combination of the two procedures combines the best of both: a strong motor signal and a spontaneous smile. Aim of this study was to objectify this expected benefit. Of the 19 patients who received a hypoglossal-facial nerve anastomosis in the period from 1995 to 2015 in our institutions, 12 patients were included in this study, five with and seven without a cross-face nerve graft. The outcomes were compared using photographs, the disease-specific quality of life (Facial Clinimetric Evaluation scale (FaCE)), a self-reported synkinesis scale (Synkinesis Assessment Questionnaire), and presence of a spontaneous smile. Significant differences were found in preoperative excursion of the affected side of the mouth and the change in excursion. Median Total FaCE scores were considerably larger (18.3 points) for patients who underwent the combined procedure. A spontaneous smile was observed both with a cross-face nerve graft (n=2) and without (n=1). The addition of a cross-face nerve graft to a hypoglossal-facial nerve anastomosis resulted in a positive trend in disease-specific quality of life. This benefit could also be present with the combination of a cross-face nerve graft with another nerve transfer such as a masseteric-facial nerve anastomosis.