What is the cross-face grafting technique for facial nerve repair?

Updated: Nov 28, 2018
  • Author: Tang Ho, MD, MSc; Chief Editor: Arlen D Meyers, MD, MBA  more...
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A facial nerve cross-face anastomosis attempts to connect branches of the facial nerve of the normal side with corresponding branches of the paralyzed side. This procedure may be chosen in cases where the proximal facial nerve of the involved side is unavailable for repair. It is made possible by the redundancy of facial nerve innervation that is often present in many areas of the face, particularly the midface.

Alternatively, a donor nerve with less associated morbidity (eg, the marginal mandibular nerve) may be sacrificed for the sake of the other side. Some iatrogenic weakness of the donor side is expected, and the patient must be well informed of this likely result before consenting to undergo the procedure.

Some facial nerve surgeons believe that donor side weakness can contribute to success, noting that many patients are happier with a more symmetric-appearing face, even at the cost of some function. This is a matter of debate. As in all reinnervation procedures, success depends on the presence of functioning motor end plates in the paralyzed side. Thus, when paralysis has lasted longer than 1 year, the likelihood of success may be compromised. The cross-face technique has had variable success in different reports and remains controversial.

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