Supercharging the Smile: A Novel Dual Nerve Transfer for Facial Reanimation

Abstract

Background: Facial paralysis has profound effects on the functional and psychosocial well-being of patients. Various surgical facial reanimation techniques have been described to address this devastating condition. While traditional surgical approaches have proved successful in restoring either facial tone or facial movement, newer combination nerve transfer techniques are addressing the limitations of the traditional single nerve transfer approaches. Methods: This study aimed to describe a promising new surgical approach to facial reanimation utilizing a dual nerve transfer to maximize both resting and active symmetry while minimizing postoperative synkinesis. Here, we use the masseteric nerve to selectively innervate the midface in combination with a hypoglossal facial nerve graft to reanimate the remaining facial regions. Results: To date, we have performed this operation on four patients, all of whom tolerated the procedure well. Our patients are showing significant improvements in both resting facial tone and facial movement with no signs of synkinesis at 9 months postoperative. Conclusions: We believe this dual nerve transfer to be superior in restoring the combination of tone, symmetry, and movement to the paralyzed face when compared with traditional single nerve transfer approaches.