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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 gracilis muscle to restore smile.


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 underneath the skin to the affected side.  At this point, the nerve is either banked for later use in a muscle transplant procedure (gracilis), or hooked up directly to the affected side facial nerve branch(es).  Borrowing the healthy facial nerve branches does NOT affect long-term 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, or leave that same night.  They will have a drain in the face which is removed prior to discharge home. Patients will have facial sutures which dissolve on their own after about 2 weeks.  If the cross-facial nerve graft is being used for a subsequent gracilis muscle transfer procedure, this will take place roughly 6-9 months after the nerve graft procedure, to allow time for axons (the fibers which carry nerve signals) to grow across the graft.

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