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What is a cross-facial nerve graft?

Cross-facial nerve grafts are performed to reinnervate paralyzed facial muscles, or improve the strength of smile muscles in partial facial paralysis.  Cross-facial nerve grafts are also used to power the gracilis muscle in gracilis free flap smile reanimation surgery (see Gracilis Free Flap).

What to expect during cross facial nerve graft procedures:

Cross-facial nerve graft procedures are performed under general anesthesia. A facelift incision is made on the healthy side of the face and one or two smile branches of the facial nerve are identified using intraoperative nerve stimulation. A small incision is made on the outside of your ankle to harvest the sural nerve for use as a nerve graft.

Once the nerve is harvested, it is transplanted to face, stitched to the healthy facial nerve smile branch(es) using cutting-edge microsurgical techniques, and passed across the upper lip to the affected side. At this point, the nerve is either banked for later use in gracilis free flap surgery or hooked up directly to the paralyzed-side facial nerve branch(es).

Borrowing the healthy facial nerve branches does NOT affect facial movement on the healthy side. Removal of the nerve from the ankle will leave a small numb patch on the outside of the foot, but it will not affect leg movement at all. Patients can still run, jump, and do all activities after surgery. Patients will typically go home the day of surgery or the following morning. If the cross-facial nerve graft is being used for a subsequent gracilis free tissue transfer procedure, this will take place 6-9 months after the nerve graft procedure to allow time for axons (the tiny fibers carrying nerve signals) to grow across the graft.


If you would like to schedule a consultation to discuss cross-facial nerve grafts, please call to schedule: 984-974-2255.