In-Service Exam
Facial - Palsy - 2001





A 36-year-old man has facial palsy on the right after sustaining a crush injury of the right mastoid. Reinnervation with cross-face nerve grafts is planned. Which of the following factors will best determine the success of this procedure?

(A) Density of contralateral facial nerve fibers
(B) Length of elapsed time between paralysis and surgery
(C) Number of cable grafts used
(D) Postoperative stimulus program with muscle re-education
(E) Use of motor donor grafts instead of sensory donor fibers

The correct response is Option B.

Cross-face nerve grafting offers the best chance of restoration of function in this patient in whom the ipsilateral proximal facial nerve stump cannot be used. The facial muscles remain viable for approximately two years; after this
timulation has not been shown to increase the likelihood of reinnervation.

There will always be a sufficient density of contralateral fibers to use as donors. As few as one to as many as four cross-face cables can be used during surgery; the number used generally depends on the condition and location of the distal stump. Postoperative muscle re-education programs offer increased control only if reinnervation actually occurs. Finally, there is no evidence that using motor rather than sensory donor grafts makes a difference in outcome.

References
1. Inigo F, Ysunza A, Rojo P, et al. Recovery of facial palsy after crossed facial nerve grafts. Br J Plast Surg. 1994;47:312.
2. Wells MD, Manktelow RT. Surgical management of facial palsy. Clin Plast Surg. 1990;14:645.