Download PDF
J Reconstr Microsurg
DOI: 10.1055/a-2726-4717
Original Article

Long-Term Implications of Combined Cross-Facial Nerve Graft and Nerve Transfer in Facial Paralysis

Authors

  • Roshni Thachil

    1   Department of Plastic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

  • Yuan Edward Wen 

    1   Department of Plastic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

  • Cristina V. Sanchez

    1   Department of Plastic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

  • Adolfo Zamaro Madrazo

    1   Department of Plastic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

  • Joan S. Reisch

    2   Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

  • Shai M. Rozen 

    1   Department of Plastic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
Further Information
Also available at
   Permissions and Reprints

Abstract

Background

Assessing the long-term implications of combining cross-facial nerve graft (CFNG) and masseteric-to-facial nerve transfer on long-term outcomes in patients with subacute facial paralysis.

Methods

Patients with subacute facial palsy who underwent a masseteric-to-facial nerve transfer with CFNG from 2013 to 2020 were reviewed. A minimum of 2-year follow-up was required with 18 patients meeting inclusion criteria. Midface and periorbital measurements on standardized photos of patients in repose, closed, and open smile were analyzed preoperatively, 3 months, 1 year, and 3 years postoperatively as available. Emotrics software (Massachusetts Eye and Ear Infirmary, Boston, MA) and ImageJ (Rasband, W.S., U.S, National Institutes of Health, Bethesda, MD) were used for measurements. Longitudinal comparisons at each timepoint were analyzed using Wilcoxon two-sample testing.

Results

In repose, 1-year measurements including Commissure-Position, Smile-Angle, and Upper-Lip–Height-Deviation, were nonsignificant, whereas significance was noted at 3 years postoperatively (p = 0.042, 0.031, 0.042, respectively). Midface dynamic smile measurements on the palsy side and with symmetry showed significant differences from preoperative measurements at 1 and 3 years postoperatively. Periorbital measurements, including Marginal-Reflex-Distance-1, Marginal-Reflex-Distance-2, and Palpebral-Fissure-Height in repose, showed no significant changes at 1 year but were significant at 3 years (p = 0.004, 0.011, and 0.002, respectively), while during animation were significant at 1 and 3 years postoperatively.

Conclusion

Combining CFNG with nerve transfer demonstrated progressive long-term improvement in resting tone and symmetry around the midface and periorbital region. Expected improvements were observed during animation over time.

Keywords

facial paralysis - nerve transfer - cross-facial nerve graft


Publication History

Received: 22 March 2025

Accepted: 07 October 2025

Accepted Manuscript online:
25 October 2025

Article published online:
13 November 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA