Cross-face nerve transfer for established trigeminal branch II palsy

Area of Science:

• Neurosurgery
• Peripheral nerve repair

Background:

• Trigeminal nerve II palsy presents reconstruction challenges.
• Traditional cross-face nerve grafts require complex microsurgical techniques and can lead to donor site morbidity.

Observation:

• A novel intraoral cross-face nerve transfer technique was applied to two patients with trigeminal nerve II palsy.
• This method utilizes supramicrosurgical techniques suitable for peripheral nerve microanatomy.

Findings:

• Successful repair of trigeminal nerve II palsy was achieved in both cases without nerve grafting.
• Patients demonstrated significant sensory recovery in the affected upper lip, with Semmes-Weinstein values ranging from 1.65 to 2.44 and moving 2-point discrimination between 15 to 30 mm at 1-1.5 years post-surgery.

Implications:

• Intraoral cross-face nerve transfer is a viable, less invasive alternative for trigeminal nerve II palsy reconstruction.
• The technique's advantages include excellent nerve regeneration, no donor site morbidity, and a simpler operative procedure compared to free nerve grafts, though it requires advanced supramicrosurgical skills.