Cross Facial Nerve Graft
Cross-facial nerve grafts are performed EITHER to provide direct
innervation of facial muscles on the affected side (the muscles which
help you smile and/or close your eye) OR to bring nerve fibers from
the healthy side to the affected side which will later be used to innervate
a transplanted muscle to restore smile or other facial movements.
Cross-facial nerve graft procedures are performed under general
anesthesia. Often, two facial nerve surgeons at the Facial Nerve Center
work together to minimize the amount of time patients are under
anesthesia. A facelift incision is performed on the healthy side of the
face and one or two smile branches of the facial nerve are identified
using a delicate nerve stimulator. Simultaneously, a 1-inch incision is
made on the outside of the ankle to harvest the sural nerve for use as
a nerve graft. The surgeon uses an endoscopic camera to harvest a long
segment of sural nerve without having to make a large incision.
Once the nerve is harvested, it is transplanted to the face, connected to the healthy facial nerve smile branch(es), and passed across the upper lip to the affected side. At this point, the nerve is either banked for later use in a muscle transplant procedure, or hooked up directly to the affected side facial nerve branch(es). Borrowing the healthy facial nerve branches does NOT affect facial movement on the healthy side. Removal of the nerve from the ankle will leave a small numb area of skin on the outside of the foot, but it will not affect leg function at all. After the procedure, patients typically stay in the hospital for one night and go home the next morning. They will have a drain in the face which is removed prior to discharge home. Patients will have facial sutures which need to be removed 1-2 weeks after surgery. If the cross-facial nerve graft is being usedfor a subsequent free tissue transfer procedure, this will take place roughly 6-9 months after the nerve graft procedure, to allow time for axons (the fiberswhich carry nerve signals) to grow across the graft.