Peripheral Nerve Surgery in Head and Neck Reconstruction: Motor Reanimation and Sensory Restoration in the Oncologic Setting

W. K. Fraser Hill; Jerry Chih-Wei Wu; Lisa Wen-Yu Chen; Johnny Chuieng-Yi Lu; David Chwei-Chin Chuang; Tommy Nai-Jen Chang

doi:10.1055/s-0045-1814140

Seminars in Plastic Surgery, Inhaltsverzeichnis

Semin Plast Surg 2025; 39(04): 265-274
DOI: 10.1055/s-0045-1814140

Review Article

Peripheral Nerve Surgery in Head and Neck Reconstruction: Motor Reanimation and Sensory Restoration in the Oncologic Setting

Autor*innen

W. K. Fraser Hill

¹Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang-Gung University, School of Medicine, Taoyuan, Taiwan
Jerry Chih-Wei Wu

¹Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang-Gung University, School of Medicine, Taoyuan, Taiwan
Lisa Wen-Yu Chen

²Elysee Aesthetics Medical Center, Taipei, Taiwan
Johnny Chuieng-Yi Lu

¹Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang-Gung University, School of Medicine, Taoyuan, Taiwan
David Chwei-Chin Chuang

¹Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang-Gung University, School of Medicine, Taoyuan, Taiwan
Tommy Nai-Jen Chang

¹Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang-Gung University, School of Medicine, Taoyuan, Taiwan

Abstract

Oncologic ablation in the head and neck region frequently results in the sacrifice of peripheral nerves and their target organs. This inevitably can compromise facial expression, ocular protection, oral competence, speech, swallowing, and cutaneous sensation, causing functional and aesthetic impairment. The application of principles from peripheral nerve surgery in these instances provides the opportunity to minimize these morbidities. For facial reanimation, targeted nerve transfers, cross-facial nerve grafting, and nuances for functioning free muscle transplantation are delineated to restore smile and spontaneous blink function. Dynamic tongue reconstruction is described for hypoglossal nerve innervated muscle flaps combined with conventional fasciocutaneous flaps for improved swallow function, bulk, and lining. Sensory reconstruction includes interposition and cross-face sural grafts to supraorbital/supratrochlear, infraorbital, lingual, and mental nerves, including corneal and lacrimal gland neurotization as potentially vision-saving procedures.

Keywords

head and neck cancer - facial nerve reconstruction - dynamic tongue reconstruction - trigeminal sensory reconstruction

Volltext

Referenzen

References
1 Kobayashi J, Mackinnon SE, Watanabe O. et al. The effect of duration of muscle denervation on functional recovery in the rat model. Muscle Nerve 1997; 20 (07) 858-866
2 Kim L, Byrne PJ. Controversies in contemporary facial reanimation. Facial Plast Surg Clin North Am 2016; 24 (03) 275-297
3 Anzil AP, Wernig A. Muscle fibre loss and reinnervation after long-term denervation. J Neurocytol 1989; 18 (06) 833-845
4 Chuang DC, Lu JC, Chang TN, Laurence VG. Comparison of functional results after cross-face nerve graft-, spinal accessory nerve-, and masseter nerve-innervated gracilis for facial paralysis reconstruction: the Chang Gung experience. Ann Plast Surg 2018; 81 (6S, suppl 1): S21-S29
5 Chuang DC. Technique evolution for facial paralysis reconstruction using functioning free muscle transplantation—experience of Chang Gung Memorial Hospital. Clin Plast Surg 2002; 29 (04) 449-459 , v
6 Labbé D, Huault M. Lengthening temporalis myoplasty and lip reanimation. Plast Reconstr Surg 2000; 105 (04) 1289-1297 , discussion 1298
7 Choudhary S, Khanna S, Mantri R, Arora P. Suprazygomatic aponeurotic McLaughlin myoplasty for facial reanimation. Ann Plast Surg 2020; 85 (02) 149-157
8 Klein HJ, Guedes T, Tzou CJ, Rodriguez-Lorenzo A. Contemporary concepts of primary dynamic facial nerve reconstruction in the oncologic patient. J Craniofac Surg 2019; 30 (08) 2578-2581
9 Chuang DC, Lu JC, Anesti K. One-stage procedure using spinal accessory nerve (XI)-innervated free muscle for facial paralysis reconstruction. Plast Reconstr Surg 2013; 132 (01) 117e-129e
10 Placheta E, Tinhofer I, Schmid M. et al. The spinal accessory nerve for functional muscle innervation in facial reanimation surgery: an anatomical and histomorphometric study. Ann Plast Surg 2016; 77 (06) 640-644
11 Terzis JK, Tzafetta K. The “babysitter” procedure: minihypoglossal to facial nerve transfer and cross-facial nerve grafting. Plast Reconstr Surg 2009; 123 (03) 865-876
12 Pannuto L, Soh JY, Duah-Asante K. et al. A novel approach to facial reanimation and restoration following radical parotidectomies. J Clin Med 2024; 13 (08) 2269
13 Biglioli F, Allevi F, Rabbiosi D. et al. Triple innervation for re-animation of recent facial paralysis. J Craniomaxillofac Surg 2018; 46 (05) 851-857
14 McGuirt WF, Welling DB, McCabe BF. Facial nerve function following irradiated cable grafts. Laryngoscope 1989; 99 (01) 27-34
15 Li SS, Mangialardi ML, Nguyen QT. et al. The chimeric scapulodorsal vascularized latissimus dorsi nerve flap for immediate reconstruction of total parotidectomy defects with facial nerve sacrifice: building a new program and preliminary results from 25 cases. Ann Plast Surg 2021; 86 (5S, suppl 3): S379-S383
16 David AP, Seth R, Knott PD. Facial reanimation and reconstruction of the radical parotidectomy. Facial Plast Surg Clin North Am 2021; 29 (03) 405-414
17 Kashiwa K, Kobayashi S, Nasu W, Kuroda T, Higuchi H. Facial nerve reconstruction using a vascularized lateral femoral cutaneous nerve graft based on the superficial circumflex iliac artery system: an application of the inferolateral extension of the groin flap. J Reconstr Microsurg 2010; 26 (09) 577-582
18 Chen LW, Lakhiani C, Huang JJ, Abdelrahman M, Huang SF, Chang TN. Holistic reconstruction of mandible defect, lower lip and chin sensation, and smile reanimation in an advanced gum cancer patient: a case report. Microsurgery 2021; 41 (04) 361-365
19 Lin CH, Wallace C, Liao CT. Functioning free gracilis myocutaneous flap transfer provides a reliable single-stage facial reconstruction and reanimation following tumor ablation. Plast Reconstr Surg 2011; 128 (03) 687-696
20 Voravitvet TY, Huang Y, Voravitvet S. et al. Dynamic eye closure restoration in facial palsy with neurotized platysma muscle graft in rats. J Reconstr Microsurg 2025; 41 (04) 330-338
21 Guelinckx PJ. Blink restoration in long-standing facial paralysis: use of free neurovascular platysma transfer. Plast Reconstr Surg Glob Open 2018; 6 (10) e1939
22 Lee KK, Terzis JK, Portmann M. Reanimation of the eye sphincter. In: Proceedings of the Fifth International Symposium on the Facial Nerve, Bordeaux, FRANCE; September 3–6, 1984 . New York: Masson Publishing; 1985:119
23 Nassif T, Yung Chia C. Neurotized platysma graft: a new technique for functional reanimation of the eye sphincter in longstanding facial paralysis. Plast Reconstr Surg 2019; 144 (06) 1061e-1070e
24 Biglioli F, Zago M, Allevi F. et al. Reanimation of the paralyzed lids by cross-face nerve graft and platysma transfer. J Craniomaxillofac Surg 2018; 46 (03) 521-526
25 Charous SJ, Hotaling JM, Burgess BD. et al. Muscle-nerve-muscle grafting for facial reanimation in rats. Ann Otol Rhinol Laryngol 2017; 126 (04) 261-267
26 Kermer C, Millesi W, Paternostro T, Nuhr M. Muscle-nerve-muscle neurotization of the orbicularis oris muscle. J Craniomaxillofac Surg 2001; 29 (05) 302-306
27 El-Kashlan HK, Carroll WR, Hogikyan ND, Chepeha DB, Kileny PR, Esclamado RM. Selective cricothyroid muscle reinnervation by muscle-nerve-muscle neurotization. Arch Otolaryngol Head Neck Surg 2001; 127 (10) 1211-1215
28 Chang YC, Vanz RL, Aurenção JC, Burgues T, Schanaider A. Unilateral frontalis muscle paralysis reanimated by contralateral frontalis muscle through sural nerve graft connecting the two muscles (muscle-nerve-muscle neurotization technique)—a case report. Microsurgery 2021; 41 (02) 181-185
29 Gilbert RJ, Napadow VJ, Gaige TA, Wedeen VJ. Anatomical basis of lingual hydrostatic deformation. J Exp Biol 2007; 210 (Pt 23): 4069-4082
30 Katsantonis GP. Neurotization of pectoralis major myocutaneous flap by the hypoglossal nerve in tongue reconstruction: clinical and experimental observations. Laryngoscope 1988; 98 (12) 1313-1323
31 Choi JW, Kim YC. Functional perspectives in tongue reconstruction based on perforator free flap. Oral Maxillofac Surg Clin North Am 2024; 36 (04) 435-449
32 Choi JW, Kim YC, Park H, Oh TS, Jeong WS. The impact of dynamic tongue reconstruction using functional muscle transfer: a retrospective review of 94 cases with functional outcome analysis for various glossectomy defects. J Craniomaxillofac Surg 2022; 50 (09) 719-731
33 Righini S, Festa BM, Bonanno MC, Colombo V, Luca N. Dynamic tongue reconstruction with innervated gracilis musculocutaneos flap after total glossectomy. Laryngoscope 2019; 129 (01) 76-81
34 Charters E, Boehm J, D'Silva AM. et al. A pilot trial of tongue reconstruction using the chimeric innervated vastus lateralis muscle and antero-lateral thigh free flap. Head Neck 2025; 47 (06) 1758-1768
35 Terrier LM, Hadjikhani N, Destrieux C. The trigeminal pathways. J Neurol 2022; 269 (07) 3443-3460
36 Rbia N, Shin AY. The role of nerve graft substitutes in motor and mixed motor/sensory peripheral nerve injuries. J Hand Surg Am 2017; 42 (05) 367-377
37 Koshima I, Narushima M, Mihara M, Uchida G, Nakagawa M. Cross-face nerve transfer for established trigeminal branch II palsy. Ann Plast Surg 2009; 63 (06) 621-623
38 Catapano J, Scholl D, Ho E, Zuker RM, Borschel GH. Restoration of trigeminal cutaneous sensation with cross-face sural nerve grafts: a novel approach to facial sensory rehabilitation. Plast Reconstr Surg 2015; 136 (03) 568-571
39 Chang YM, Rodriguez ED, Chu YM, Tsai CY, Wei FC. Inferior alveolar nerve reconstruction with interpositional sural nerve graft: a sensible addition to one-stage mandibular reconstruction. J Plast Reconstr Aesthet Surg 2012; 65 (06) 757-762
40 Pu JJ, Chang TN, Su YX. End-to-side cross-face nerve graft for mental nerve reconstruction after segmental mandibulectomy. Plast Reconstr Surg 2025; 156 (01) 120e-123e
41 Dr T, E P, J D, et al. The surgical management of extra-cranial trigeminal nerve palsies: A retrospective case series. J Plast Reconstr Aesthet Surg 2021; 74 (09) 2258-2264
42 Hanwright P, Yang R, Chopra K, Dorafshar A, Dellon AL, Williams E. A surgical approach to treat painful neuromas of the supraorbital and supratrochlear nerves with implantation of the proximal stump into the orbit. Craniomaxillofac Trauma Reconstr 2019; 12 (04) 305-308
43 Jacobs T, Mohammed S, Ziccardi V. Evaluating lingual nerve repair outcomes: a systematic review. J Oral Maxillofac Surg 2024; 82 (10) 1212-1223
44 Elfring TT, Boliek CA, Seikaly H, Harris J, Rieger JM. Sensory outcomes of the anterior tongue after lingual nerve repair in oropharyngeal cancer. J Oral Rehabil 2012; 39 (03) 170-181
45 Bains RD, Elbaz U, Zuker RM, Ali A, Borschel GH. Corneal neurotization from the supratrochlear nerve with sural nerve grafts: a minimally invasive approach. Plast Reconstr Surg 2015; 135 (02) 397e-400e
46 Terzis JK, Dryer MM, Bodner BI. Corneal neurotization: a novel solution to neurotrophic keratopathy. Plast Reconstr Surg 2009; 123 (01) 112-120
47 Lin CH, Lai LJ. Herpetic corneal keratopathy management using ipsilateral supratrochlear nerve transfer for corneal neurotization. Ann Plast Surg 2019; 83 (05) 553-557
48 Ho YR, Lin CH, Kuo CY. The protective effect of simvastatin against ultraviolet B-induced corneal endothelial cell death. Indian J Ophthalmol 2018; 66 (08) 1080-1083
49 Hung KH, Yeh LK, Wu WC, Lin CH. Clinical outcomes of corneal neurotization in patients with herpetic neurotrophic keratopathy. Ann Plast Surg 2025; 95 (05) 537-542
50 Gross JN, Bhagat N, Tran K. et al. Minimally invasive corneal neurotization: 10-year update in technique including novel donor transfer of the great auricular nerve. Plast Reconstr Surg 2024; 154 (04) 795e-798e
51 Molinari ME, Huntermann R, Pedrotti Chavez M, Cristiane Lopes S, de Oliveira Coronel Camacho A. Efficacy of corneal neurotization surgery in eyes with neurotrophic keratopathy: a systematic review and meta-analysis. Ann Plast Surg 2025; 95 (06) 672-679
52 Lin H, Yiu SC. Dry eye disease: a review of diagnostic approaches and treatments. Saudi J Ophthalmol 2014; 28 (03) 173-181
53 Geerling G, Garrett JR, Paterson KL. et al. Innervation and secretory function of transplanted human submandibular salivary glands. Transplantation 2008; 85 (01) 135-140
54 Murube J, Geerling G. Mechanical pump dacryoreservoirs. Dev Ophthalmol 2008; 41: 269-282
55 Giannaccare G, Bolognesi F, Fogagnolo P. et al. Sural nerve vertical cross-face graft for lacrimal gland neurotization to improve tear secretion in neurodeprivative dry eye. Cornea 2023; 42 (01) 121-126
56 Strianese A, Bolognesi F, Giannaccare G. et al. Long-term outcomes of sural nerve vertical cross-face graft for lacrimal gland neurotization in neurodeprivative dry eye. Graefes Arch Clin Exp Ophthalmol 2025; 263 (04) 1045-1049