Stage 1 - Cross-Facial
Nerve Grafting for
Smile
Extended Edition (1.140425.140520)
Facial paralysis causes significant morbidity and dynamic reconstruction aims to address functional, aesthetic, and psychological aspects of the impairment. Cross-facial nerve grafting is a reconstructive strategy used to restore smile
function and eye closure in both acute and chronic unilateral injury. In an acute injury, nerve grafting provides regenerating fibers from the donor nerve on the normal side to reinnervate across the face to the similar recipient nerve on the paralyzed side. In a chronic injury where
the paralyzed muscle can no longer be reinnervated, the cross-facial nerve graft serves as the first stage to a segmental free functional muscle transfer to reconstruct smile. In this case, the patient presented 4-years-ago with a posterior fossa medulloblastoma, which was removed, and underwent a successful course of chemotherapy. However, the tumor involved partial
CN12 and complete CN6 and CN7 nerve paralysis on the left side.
Reconstruction included a 2-stage segmental gracilis muscle transfer to reconstruct smile with stage one providing the donor nerve source for the muscle. This video details the selection of the donor buccal branch of the contralateral facial nerve and coaptation of the sural nerve graft as the cross-facial nerve graft. The specifics of the sural nerve harvest are not included in this video.
Table of Contents (Extended)
00:30 Pre-operative Discussion
06:39 Developing a Facial
Pocket with Unipolar Cautery
09:55 Developing a Facial Pocket with
Scissor Dissection
12:48 Identifying and Exposing the Contralateral Buccal
Branch of
Facial Nerve
16:03 Mapping of Contralateral Facial Nerve through Electrical
Stimulation
18:43
Exposure of Upper Gingival Buccal Sulcus to the Periosteum
19:43 Tunneling the Nerve
Graft from the Upper Buccal Sulcus to the Buccal Nerve Branch
21:33 Dividing the Buccal Branch of Contralateral Facial Nerve
22:26 Coaptating the Buccal Branch to the Proximal End of Nerve Graft
23:50
Suturing the Distal End of Nerve Graft to the Periosteum
26:00
Closure
26:50 Post-operative Discussion
Authors:
Ronald M. Zuker,
Gregory H. Borschel,
Karen W. Y. Wong,
Alison K. Snyder-Warwick,
Andrew Yee
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- published: 28 Jul 2014
- views: 3904