Abstract
Background
Assessing the long-term implications of combining cross-facial nerve graft (CFNG)
and masseteric-to-facial nerve transfer on long-term outcomes in patients with subacute
facial paralysis.
Methods
Patients with subacute facial palsy who underwent a masseteric-to-facial nerve transfer
with CFNG from 2013 to 2020 were reviewed. A minimum of 2-year follow-up was required
with 18 patients meeting inclusion criteria. Midface and periorbital measurements
on standardized photos of patients in repose, closed, and open smile were analyzed
preoperatively, 3 months, 1 year, and 3 years postoperatively as available. Emotrics
software (Massachusetts Eye and Ear Infirmary, Boston, MA) and ImageJ (Rasband, W.S.,
U.S, National Institutes of Health, Bethesda, MD) were used for measurements. Longitudinal
comparisons at each timepoint were analyzed using Wilcoxon two-sample testing.
Results
In repose, 1-year measurements including Commissure-Position, Smile-Angle, and Upper-Lip–Height-Deviation,
were nonsignificant, whereas significance was noted at 3 years postoperatively (p = 0.042, 0.031, 0.042, respectively). Midface dynamic smile measurements on the palsy
side and with symmetry showed significant differences from preoperative measurements
at 1 and 3 years postoperatively. Periorbital measurements, including Marginal-Reflex-Distance-1,
Marginal-Reflex-Distance-2, and Palpebral-Fissure-Height in repose, showed no significant
changes at 1 year but were significant at 3 years (p = 0.004, 0.011, and 0.002, respectively), while during animation were significant
at 1 and 3 years postoperatively.
Conclusion
Combining CFNG with nerve transfer demonstrated progressive long-term improvement
in resting tone and symmetry around the midface and periorbital region. Expected improvements
were observed during animation over time.
Keywords
facial paralysis - nerve transfer - cross-facial nerve graft
