Trigeminal Nerve Reconstruction, State Of The Art In Facial Reanimation
Alexander Cárdenas Mejía, MD1; Gerardo Muñoz-Jiménez, MD2; Sara M. Contreras-Mérida, MD2; (1)Plastic and Reconstructive Surgery, Hospital General Dr. "Manuel Gea González", Mexico City, Mexico, (2)Hospital General Dr. Manuel Gea González, Mexico, Mexico
In the face, the trigeminal nerve is mainly sensitive, and facial nerve mostly motor, despite both are mixed nerves. Historically facial reanimation has focus in motor function of the facial nerve, leaving aside sensitivity and motor function of the trigeminal. Both nerves together allow specialized skills, so facial reanimation should include the reconstruction of the trigeminal in case of damage.
Objective: To present reconstructive options in facial reanimation focused on the trigeminal nerve, presenting demonstrative cases.
Methodology: A case series with trigeminal nerve injury treated with microsurgical methods for both sensory and motor facial resuscitation of the V pair.
Results:
Case 1: 32-year-old female, Schwannoma sequelae and left hemifacial paralysis plus left hemifacial anesthesia treated initially with cross face nerve grafts: buccal-buccal, zygomatic-zygomatic and marginal-marginal. 4 years later sensitive cross face nerve grafts: Infraorbital-Infraorbital and mental-mental were done. Resulting in BMRC scale: S3/S3+ in left hemiface and improvement in: fluid continence, phonation, cheek bite frequency and kissing sensitivity.
Case 2: 14-year-old female, with right facial nerve and trigeminal damage as trauma sequel. Had no corneal protection reflex, right corneal opacity, hyperemic conjunctiva. Initial reconstruction: gold weight in right eyelid, medial cantoplasty, buccal cross face nerve graft (for a gracilis flap in a late procedure), cross face nerve graft for corneal reinnervation (right supratrochlear nerve – sclerocorneal junction). Resulting in right eye closure recovery, blink reflex and corneal sensitivity recovery, improvement of tear film and corneal lesions.
Case 3: 14-year-old female, with hemifacial microsomy, Pruzansky 2b and congenital absence of masseter muscle. Left mandibular distraction was done initially and free muscle transfer of gracilis to reconstruction of masseter muscle in a second procedure. Resulting in increased bone density and bone growth at the site of the free muscle transfer.
Conclusion: The refinement of facial reanimation reconstructing the trigeminal nerve will result in optimal function and facial aesthetics in case of isolated trigeminal nerve damage, and superior results when reconstructing both (trigeminal and facial nerves) if the patient present double injury.
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