Peripheral Nerve Surgery in Head and Neck Reconstruction: Motor Reanimation and Sensory Restoration in the Oncologic...

Oncologic ablation in the head and neck region frequently results in the sacrifice of peripheral nerves and their target organs. This inevitably can compromise facial expression, ocular protection, oral competence, speech, swallowing, and cutaneous sensation, causing functional and aesthetic impairment. The application of principles from peripheral nerve surgery in these instances provides the opportunity to minimize these morbidities. For facial reanimation, targeted nerve transfers, cross-facial nerve grafting, and nuances for functioning free muscle transplantation are delineated to restore smile and spontaneous blink function. Dynamic tongue reconstruction is described for hypoglossal nerve innervated muscle flaps combined with conventional fasciocutaneous flaps for improved swallow function, bulk, and lining. Sensory reconstruction includes interposition and cross-face sural grafts to supraorbital/supratrochlear, infraorbital, lingual, and mental nerves, including corneal and lacrimal gland neurotization as potentially vision-saving procedures.