Long-term outcome in 38 consecutive permanent recent facial palsy patients after triple innervation technique

In total, 38 patients who underwent the triple innervation technique in an effort to restore a permanent recent unilateral facial palsy were retrospectively assessed for long-term outcomes in order to ascertain the efficacy of the technique and the stability of the results. The surgical approach used involves the restoration of voluntary movement using both masseteric and hypoglossal nerves, the contralateral facial nerve for spontaneous movement, and some static techniques (midface soft-tissue suspension with fascia lata graft, lateral tarsorrhaphy, and lipofilling of the upper eyelid) in order to enhance the symmetry at rest. During April 2024, EFACE grading was used to assess morphological and functional outcomes using pre- and 24-month postoperative pictures and videos. The Wilcoxon signed-rank test for paired groups showed a statistically significant improvement in facial symmetry and in the range of voluntary movements within the treated population. Moreover, the comparison of median values of the spontaneous parameters suggested good effectiveness of this kind of surgery. Blinking was restored in 36 patients. This result also correlated with a decreased need for artificial tears postoperatively. Excellent outcomes were also achieved in restoring the empathic smile, with 37 patients showing improvement. Triple innervation is one of the techniques currently used to obtain static and dynamic recovery from permanent recent facial paralysis: the results are reproducible and increase morphologically and functionally over time. Moreover, by assessing results at 24 months after surgery, the long-term evaluation suggests excellent stability of the morphological outcomes.