Delay Between Cross-Facial Nerve Graft and Free Functional Muscle Transfer Does Not Affect Nerve Viability for Facial Reanimation
Christopher D Lopez, MD, Cynthia T Yusuf, BS, Robin Yang, MD, DDS, Kofi D O Boahene, MD and Richard J. Redett, MD FACS, Johns Hopkins School of Medicine, Baltimore, MD
Introduction: Cross-facial nerve grafting (CFNG) with free functional muscle transfer (FFMT) is a mainstay treatment for facial reanimation. These procedures are usually done in a predictably staged fashion, but events such as the COVID-19 pandemic resulted in significant delays between CFNG and FFMT for patients at our institution. The impact of these delays on CFNG viability for facial reanimation is unknown.
Materials & Methods: A retrospective study of patients who underwent both CFNG and gracilis FFMT was performed from 2016 to 2023. Predictor variables included race, ethnicity, age, time between CFNG and FFMT, and dual nerve transfer (masseteric + CFNG to gracilis) characteristics. Primary outcomes were time to first facial movement and time to spontaneous smile (alpha <0.05). Multiple linear regressions were performed.
Results: Twenty-nine patients that underwent both CFNG and FFMT were included. Time between CFNG and FFMT ranged from 0 to 2811 days. Surprisingly, time between CFNG and gracilis FFMT procedures did not influence time to first facial movement (β: -0.092, t: -1.92, p = 0.057) or time to spontaneous smile (β: 0.061, t:0.931, p = 0.339). Time to first facial movement was significantly shorter in the dual nerve transfer cohort (147, IQR: 118.5, 197.25) compared to the single nerve transfer group (202, IQR: 145, 361 days) (p= 0.048), and on multiple linear regression, dual innervation was a significant predictor variable of time to first facial movement (β: -124.8, t: -2.32, p = 0.018).
Conclusions: Conventional staging intervals between CFNG and FFMT could be prolonged if/when needed without adverse effects on nerve viability. Larger cohort studies are warranted. Potential implications of these findings include preventative CFNG for all patients that sustain facial palsy in efforts to address the current ~30% of patients that have poor/limited recovery.
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