Cross facial nerve
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Facial Nerve Repair Technique
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Dynamic reanimation for facial paralysis treatment
In this chapter, we highlight the pearls and pitfalls of cross facial nerve grafting. Cross-facial nerve graft. A sural nerve graft is ideal given the accessibility of the nerve, the length, as well as the reliability and ease of the nerve harvest. An incision was planned out in the preauricular crease with temporal and cervical extension, and made with a 15 blade, approximately 14 cm in length. At this point, the facial nerve branches at the junction of the parotid gland and masseteric fascia were identified and stimulated using the Parsons-McCabe nerve simulator. A sural nerve graft was harvested subcutaneously from the right leg in the usual fashion using a tendon stripper. The nerve is then passed by attaching it to a fascia passer with silk through the sublabial incisions created in the upper lip on the ipsilateral side. The nerve was severed distally and then a nerve stripper was placed over the nerve and used to dissect the nerve free from surrounding tissues more proximally to adequate length. The sublabial incisions were then closed using chromic suture in an interrupted fashion. However, in recent years, the use of cross facial nerve grafting with a second stage gracilis free flap has gained popularity due to the ability to generate a spontaneous smile and facial movement. A facelift-type compression dressing is then applied. Sural Nerve Graft Harvest Leg incision is closed with buried monocryl sutures, steri-strips and ace wrap.
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