The Babysitter Procedure: Minihypoglossal to Facial Nerve Transfer and Cross-Facial Nerve Grafting

Background: In 1984, Terzis introduced the babysitter procedure, a new concept in facial reanimation. It involves two stages, with coaptation of ipsilateral 40 percent hypoglossal to facial nerve on the affected side, performed concomitantly with cross-facial nerve grafting and secondary microcoaptations 8 to 15 months later. This article presents the senior author's (J.K.T.) experience with the original procedure. Methods: Of 75 patients who had minihypoglossal nerve transfer, 20 fulfilled the selection criteria for the original babysitter procedure. All patients' records, photographs, videotapes, and needle electromyography studies were reviewed. The clinical results were scored using Terzis' Grading Scale. Eye closure, smile, and lower lip depression were each assessed separately. Functional and aesthetic outcomes and preoperative and postoperative electromyography results were analyzed. Results: Seventy-five percent of patients achieved excellent and good results, 15 percent had moderate results, and 10 percent had fair results. The difference between preoperative and postoperative eye closure was statistically significant (t test, p < 0.001). Symmetrical smile and full contraction (excellent result) was achieved in two patients (10 percent), 13 patients (65 percent) had nearly symmetrical smile (good result), and five patients (25 percent) had a moderate result. Two patients (10 percent) had full lower lip depression (excellent result) and 15 (75 percent) had good results. In three patients (15 percent), subsequent digastric or platysma muscle transfer was performed because of inadequate depression and symmetry (moderate result). A statistically significant difference was observed between preoperative and postoperative electromyography results, in eye closure, smile, and lower lip depression. Conclusions: The original babysitter procedure offers significant improvement in selected patients with facial paralysis. Symmetry and coordinated movements can be restored, with satisfying aesthetic and functional outcomes. (Plast. Reconstr. Surg. 123: 865, 2009.)