Surgical Procedures

Stage 1 – Cross-Facial Nerve Grafting for Smile

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.

Standard 140520

Extended 140520




Pre-auricular incision.


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Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.

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