Nerve Transfer Sources for Facial Reanimation

Background: Facial paralysis is a cosmetically and emotionally damaging injury. Reestablishing effective and aesthetically pleasing results for facial reanimation is a challenge that may be achieved with nerve transfers.

Objective: We sought to delineate the landmarks and axon counts of potential donors for nerve transfer for facial reanimation.

Methods: 10 hemifaces were dissected to identify donor nerve anatomy, distances and possible coaptation options were evaluated. Axon counts were measured on nerve branches selected for transfer. Nerve donor branches evaluated were the 1) deep temporal branch, and 2) masseteric branch of the trigeminal nerve and the 3) hypoglossal nerve.

Results: In all 10 hemifaces, donor nerves could be easily identified in relationship to palpable skeletal landmarks. The average coaptable length of the deep temporal branch was 19 mm prior to sub-millimeter ramification. The average coaptable length of the deep temporal branch was 6 mm prior to sub-millimeter ramification. The average axon count of the hypoglossal nerve was [pending]. All nerve transfers, including masseter and deep temporal branches, could be performed above the superficial surface of the muscle they innervated.

Conclusion: Anatomic landmarks provide consistent relationship for identifying donor nerves for transfer for facial reanimation. Axon counts and favorable anatomy for harvesting nerve pedicles allow for options in achieving maximal therapeutic results.