Facial plast Surg 2015; 31(02): 128-133
DOI: 10.1055/s-0035-1549046
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Cross-Facial Nerve Grafting for Facial Reanimation

Grace Lee Peng2, 3, Babak Azizzadeh1, 3
  • 1Department of Otolaryngology—Head and Neck Surgery, University of California, Los Angeles, California
  • 2Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, Keck School of Medicine at the University of Southern California, California
  • 3Center for Advanced Facial Plastic Surgery, Beverly Hills, California
Further Information

Publication History

Publication Date:
08 May 2015 (online)


Dynamic facial reanimation is the gold standard treatment for a paralyzed face. Over the last century, multiple nerves have been utilized for grafting to the facial nerve in an attempt to produce improved movement. However, in recent years, the use of cross facial nerve grafting with a second stage gracilis free flap has gained popularity due to the ability to generate a spontaneous smile and facial movement. Preoperative history taking and careful examination, as well as pre-surgical planning, are imperative to whether cross facial nerve grafting with a second stage gracilis free flap is appropriate for the patient. A sural nerve graft is ideal given the accessibility of the nerve, the length, as well as the reliability and ease of the nerve harvest. The nerve can be harvested using a small incision, which leaves the patient with minimal post operative morbidity. In this chapter, we highlight the pearls and pitfalls of cross facial nerve grafting.