Functional outcomes of dual nerve transfer in patients with facial paralysis

Facial paralysis, as a social-facing disorder, is associated with high levels of depression, anxiety, and social isolation. Dual nerve transfers allow for simultaneous coaptation of the hypoglossal and masseteric nerves to improve dynamic and static domains of facial function. In this study, we investigated clinician-graded long-term functional outcomes as well as their impact on disease-specific quality of life and communicative perception in patients with facial paralysis after dual nerve transfer surgery.

Retrospective data of 8 patients with facial paralysis who underwent dual nerve transfers at a single tertiary center between 2018 and 2021 were analyzed. Pre- and postoperative outcomes were compared using the electronic clinician-graded facial function scale (eFACE), Facial Clinimetric Evaluation scale (FaCE), and Communicative Participation Item Bank (CPIB) survey.

The average age of the 8 patients was 51±16 years and average denervation time was 13.6±5.4 months. The average follow-up time at which postoperative scores were obtained was 12.4±3.9 months. Composite eFACE scores increased 25±7 points, with the dynamic and static subdomains improving by 39±10 and 38±18 points, respectively. Commissural excursion increased by an average of 68±24, whereas synkinesis worsened by 9±6 points. The FaCE and CPIB quality of life surveys showed an improvement of 9.5±5 and 5.1±6.6, respectively. Only one postoperative complication was recorded, a seroma requiring in-clinic drainage.

Dual nerve transfers show statistically and clinically significant improvements in all eFACE domains except for an increase in synkinesis. Patients also report improvement in quality of life and communicative perception.