Reanimation of reversible facial paralysis by the double innervation technique using an intraneural-dissected sural nerve graft

In treating reversible facial paralysis, cross-facial nerve grafting offers voluntary and emotional reanimation. In contrast, rapid re-innervation and strong neural stimulation can be obtained with hypoglossal-facial nerve crossover. In this article, we describe the method of a combination of these techniques as a one-stage procedure. A 39-year-old man presented with facial paralysis due to nerve avulsion within the stylomastoid foramen. The sural nerve was harvested and two branches were created at its distal end by intraneural dissection. One branch was anastomosed to the contralateral facial nerve, and the other branch was used for hypoglossal-facial nerve crossover, followed by connecting the proximal stump of the graft to the trunk of the paralysed facial nerve in an end-to-end fashion. At 9 months postoperatively, almost complete facial symmetry and co-ordinated movements of the mimetic muscles were obtained with no obvious tongue atrophy. Since our method can efficiently gather neural inputs from the contralateral facial nerve and the ipsilateral hypoglossal nerve, it may become a good alternative for reanimation of reversible facial paralysis when the ipsilateral facial nerve is not available. (C) 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.