Donor Nerve Selection in Facial Reanimation Surgery

The motor components of local cranial nerves provide a series of options for the surgical rehabilitation of the paralyzed face. Nerve donor sites vary with respect to their motor power, functional deficit, and synergy with facial expression. A thorough understanding of each donor nerve's strengths and weaknesses facilitates the selection process. Technical modifications to reduce donor site morbidity and the emerging role of the masseter nerve are examined.

KEYWORDS

Facial nerve paralysis - trigeminal motor nerve - cross-face nerve graft - hypoglossal nerve transfer - facial reanimation

REFERENCES

• 1 Pensak M L, Jackson G G, Glasscock M E et al.. Facial reanimation with the XII-VII anastomosis: analysis of the function and psychological results.  Otolaryngol Head Neck Surg. 1986;  94 305-310
• 2 May M. Nerve substitution techniques: XII-VII hook-up, XII-VII jump graft and cross-face graft. In: May M The Facial Nerve. May's 2nd ed. New York; Thieme Medical Publishers 2000: 611-633
• 3 Spira M. Anastomosis of masseteric nerve to lower division of facial nerve for correction of lower facial paralysis.  Plast Reconstr Surg. 1978;  61 330-334
• 4 Frydman W, Heffez L, Jordan S et al.. Facial muscle reanimation using the trigeminal motor nerve: an experimental study in the rabbit.  J Oral Maxillofac Surg. 1990;  48 1294-1304
• 5 Bae Y C, Zuker R, Manktelow R et al.. Comparative study of results after gracilis muscle transplant for facial animation in children according to innervated motor nerve: cross-facial nerve graft vs. the masseteric nerve. Paper presented at the Annual Meeting of the American Society for Reconstructive Microsurgery; January 11 2003 Kauai, Hawaii;
• 6 Luxford W, Brackmann D E. Facial nerve substitution: a review of sixty-six cases.  Am J Otolaryngol. 1985;  Suppl 55-57
• 7 Baker D. Hypoglossal facial nerve anastomosis indications and limitations. In: Portmann MD Proceedings of the Fifth International Symposium Facial Nerve. New York; Masson Publishing USA 1985: 526-529
• 8 Manktelow R, Tomat L, Chang M et al.. Does cerebral adaptation occur when the Vth nerve is used for facial paralysis reconstruction in adults?. Paper presented at the American Association of Plastic Surgeons 81st Annual Meeting; April 29 2002 Seattle, Washington;
• 9 Rubin L, Rubin P, Simpson R et al.. The search for the neurocranial pathways to the fifth nerve nucleus in the reanimation of the paralyzed face.  Plast Reconstr Surg. 1999;  103 1725-1728
• 10 Cheney M, McKenna M, Megerian C et al.. Trigeminal neo-neurotization of the paralyzed face.  Ann Otol Rhinol Laryngol. 1997;  106 733-738
• 11 Adour K, Klein J, Bell D. Trigeminal neurotization of paralyzed facial musculature.  Arch Otolaryngol. 1979;  105 13-16
• 12 Bowden R, Mahram Z. Experimental and histological studies of the extra petrous portion of the facial nerve and its communications with the trigeminal nerve in the rabbit.  J Anat. 1960;  94 375-386
• 13 Gasser R F. The development of the facial nerve in man.  Ann Otol Rhinol Laryngol. 1967;  76 37-56
• 14 Baumel J. Trigeminal-facial nerve communications.  Arch Otolaryngol. 1974;  99 34-44
• 15 Conley J. Hypoglossal crossover-122 cases.  Trans Am Acad Ophthalmol Otolaryngol. 1977;  84 763-768
• 16 Myckatyn T, Mackinnon S. The surgical management of facial nerve injury.  Clin Plast Surg. 2003;  30 307-318
• 17 Atlas M D, Lowinger D. A new technique for hypoglossal-facial nerve repair.  Laryngoscope. 1997;  107 984-991
• 18 Mackinnon S E, Dellon A L, Hunter D A. Histological assessment of the effects of the distal nerve in determining regeneration across a nerve graft.  Microsurgery. 1988;  9 46-51
• 19 Endo T, Hata J, Nakayama Y. Variations on the “baby-sitter” procedure for reconstruction of facial paralysis.  J Reconstr Microsurg. 2000;  16 37-43
• 20 Baker D C. Facial paralysis. In: McCarthy J Plastic Surgery. Vol 3: The Face. Philadelphia; WB Saunders 1990: 2277-2284
• 21 Griebie M S, Huff J S. Selective role of partial XI-VII anastomosis in facial reanimation.  Laryngoscope. 1998;  108 1664-1668
• 22 Thulin C A. Follow-up study of spinal accessory-facial nerve anastomosis with special reference to the electromyographic findings.  J Neurol Neurosurg Psychiatry. 1964;  27 502-506
• 23 Perret G. Results of phrenicofacial nerve anastomosis for facial paralysis.  Arch Surg. 1967;  94 505-508
• 24 Fackler C D, Perret G E, Bedell G N. Effect of unilateral phrenic nerve section on lung function.  J Appl Physiol. 1967;  23 923-926