Cross Facial Nerve Grafting
In the crossfacial nerve graft, the unaffected
facial nerve is exposed at distal buccal branches through a modified facelift
incision. The nerve graft is performed with the sural or
superficial peroneal nerve of the leg. If the paralysis is of short
duration and traumatic, then the cross facial nerve graft can be repaired to the
injured distal stump of the facial nerve on the affected side. In long
standing paralysis, the nerve graft is left with a free end on the affected side
of the face. The patient is followed by serial examinations to assess
growth of never fibers in the graft using a Tinel's sign. When the nerve
growth has reached the other side of the face, a functional muscle transplant
can be performed.
 
Functional Muscle Transplantation
The gracillis functional muscle is brought to the
face and positioned under the skin with a modified face lift incision. The
blood vessels are repaired microsurgically to the facial artery and vein to
establish blood flow in the muscle. The cross facial nerve graft is then
coapted to the gracillis obturator nerve. Muscle function usually begins
to appear after 2 to 3 months.
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