Otolaryngology—Head & Neck Surgery

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Complex Case Spotlight

Multinerve Transfer Technique Improves Facial Reanimation


Enhanced Segmented Movement via Multiple Grafts

A new approach to facial reanimation developed by surgeons at NYU Langone Health connects distal branches of the facial nerve to multiple local and regional nerves. The technique is applicable for patients with abnormal nerve growth, such as those with Bell’s palsy, or patients with nerve loss whether due to a degenerative condition or prior surgery. Here, a patient demonstrates left facial paralysis possibly due to a genicular ganglion hemangioma.

A patient demonstrating left facial paralysis.
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Up to Four Distinct Nerve Connections

The masseteric nerve is connected to the distal end of the midface division. The lower division of the facial nerve is connected to the hypoglossal nerve to animate the lower face. The ansa cervicalis is connected to the upper division of the face to give tone to the eye muscles. A cross-face nerve graft may be used to innervate the affected midface with input from the intact contralateral midface division.

Illustration depicting four possible nerve connections utilized in the new multigraft facial reanimation approach. IMAGE: Andrew Lee, MD, artist.
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Rapid Functional Improvement

The nuanced reconstruction technique requires muscular transfer or transplant and takes longer than traditional facial reanimation techniques as each nerve is transferred and carefully grafted. However, surgeons have not observed significantly longer patient recovery times, with most patients experiencing some functional recovery 3–12 months after surgery.

Surgeon’s view during a nerve graft procedure.
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Facial Reanimation with Less Synkinesis

Patients benefit from facial reinnervation that enables specialized movement, with less synkinesis than traditional single-graft techniques. Here, the patient who experienced left facial paralysis demonstrates segmented movement made possible by the multigraft technique. Follow-up photos were taken two years post-surgery. Read The Full Article

A patient demonstrating segmented movement following multigraft facial reanimation to address left facial paralysis.
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