Triple nerve transfers for the management of early unilateral facial palsy
Jose E Telich Tarriba, MD1, Alexander Cárdenas Mejía, MD2, David F Navarro-Barquin, MD3 and Genesis B Pineda-Aldana, MD4, 1Hospital Angeles del Pedregal, Mexico City, DF, Mexico, 2Plastic and Reconstructive Surgery, Hospital General Dr. "Manuel Gea González", Mexico City, DF, Mexico, 3Hospital General "Dr. Manuel Gea Gonzalez", Mexico city, DF, Mexico, 4Hospital General "Dr. Manuel Gea Gonzalez", Mexico City, DF, Mexico
Background: Early onset facial paralysis is usually managed with cross-face nerve grafts, however the low number of axons that reach the target muscle may result in weakness or failure. Multiple-source innervation, or “Supercharging”, seeks to combine the advantages of different donor nerves while minimizing their weaknesses. We propose a combination of cross-face nerve grafts with local extra-facial nerve transfers to achieve earlier facial reanimation in our patients.
Methods: A retrospective cohort including all patients with early unilateral facial palsy (< 12 months evolution) who underwent triple nerve transfer between 2019 and 2021 was conducted. We performed s single-stage procedure including zygomatic-to-zygomatic and buccal-to-buccal cross-face grafts, a nerve-to-masseter to bucozygomatic trunk transfer, and a mini-hypoglossal to marginal branch transfer. Results were evaluated using the clinician-graded facial function scale (eFACE).
Results: Fifteen patients were included (8 females, 7 males), mean age at the time of surgery was 48.9 ± 13.3 years. Palsy was right-sided in 8 cases. The mean time from palsy onset to surgery was 5.5 ± 2.8 months. Patients showed improvement in static (70.8 ± 21.9 vs 84.15 ± 6.68, p = 0.002) and dynamic scores (20 ± 16.32 vs 74.23 ± 7.46, p < 0.001), as well as periocular (57.33 ± 15.23 vs 74 ± 7.18, p = 0.007), smile (54.73 ± 11.93 vs 85.62 ± 3.86, p < 0.001), mid-face (46.33 ± 18.04 vs 95 ± 7.21, p < 0.001) and lower face scores (67.4 ± 1.55 vs 90.31 ± 7.54, p < 0.001).
Conclusion: The triple nerve transfer technique using cross-face nerve grafts, the nerve-to-masseter, and the hypoglossal nerve, is an effective and reproducible technique to obtain middle and lower face reanimation in cases of early facial palsy.
Back to 2024 Abstracts