Dual nerve transfer for postoperative facial paralysis: a 4-year clinical outcome report

To present our experience with the dual nerve transfer technique for facial nerve reanimation, combining the hypoglossal and masseteric nerves to restore resting tone and voluntary smiling in short-term postoperative paralysis.

We conducted a retrospective analysis of 22 patients who underwent dual nerve transfer surgery at a tertiary care hospital over a 4-year period. Demographic, surgical, and follow-up data were collected. The Sunnybrook Scale and the Facial Clinimetric Evaluation Scale (FaCE) were recorded pre- and post-operatively to evaluate changes in facial movement and the impact of treatment on quality of life.

All patients had complete postoperative facial nerve paralysis, primarily following skull base surgery (mainly vestibular schwannoma excision). The majority were women in their fifties, and surgery was performed an average of seven months after the initial procedure. Initial voluntary movement was reported at three to four months, becoming evident and spontaneous around six months post-surgery. All patients showed significant improvements in facial symmetry and quality of life, with minimal complications reported.

Dual nerve transfer is a reproducible technique that provides satisfactory tone and movement in patients with postoperative facial paralysis. It offers minimal donor site morbidity, a low incidence of complications and synkinesis, and a positive impact on quality of life.