Cross Facial Nerve Grafting for Smile Restoration: Thoughts on Improving Graft Inset

Area of Science:

• Plastic Surgery
• Neurosurgery
• Microsurgery

Background:

• Cross facial nerve grafts (CFNGs) are a cornerstone of facial reanimation surgery.
• Their application in two-stage smile reanimation strategies can present challenges, including graft identification and potential injury during subsequent procedures.

Purpose of the Study:

• To present technical modifications for the initial placement (inset) of CFNGs.
• To enhance the ease and safety of the second stage of facial reanimation surgery, particularly for smile restoration.

Main Methods:

• Modification 1: Marking CFNG course with surgical clips and loose sutures to prevent displacement.
• Modification 2: Routing CFNGs through nasal sills to protect them during free functional muscle transfer.
• Modification 3: Routing CFNGs over the zygomatic arch from the lateral nose to the preauricular area for easier dissection and adequate length.

Main Results:

• The proposed modifications aim to simplify CFNG identification in the second surgical stage.
• These techniques are designed to minimize the risk of iatrogenic injury to the banked nerve graft.
• The routing modifications facilitate tension-free coaptation and offer flexibility in nerve connection positioning.

Conclusions:

• Implementing these technical modifications in the first stage of CFNG surgery can significantly improve the safety and efficiency of two-stage facial reanimation.
• These strategies are particularly beneficial for smile reanimation, reducing complications and optimizing outcomes.