Facial reanimation by cross-facial nerve grafting: report of five cases.

Facial nerve repair is a dynamic reanimation technique. Direct nerve repair by suturing or grafting can provide good results within a specific time frame. Immediate nerve repair has been successful in cases of laceration injuries, but nerve grafting techniques are typically delayed when it is clear that direct suturing to the nerve trunk cannot be achieved without tension. Delayed nerve grafting is also employed following ablative procedures and in cases of trauma that cause segmental nerve deficits. Cross-facial nerve grafting is particularly useful when the peripheral branches are intact and the main trunk of the facial nerve is inaccessible. This method is also typically performed in a delayed fashion. Rehabilitation of the facial nerve and subsequent reinnervation of the mimetic motor endplates are achieved through axonal growth. In this article, we describe a consecutive series of five patients who developed facial paralysis following cranial surgery for acoustic neuroma. Each underwent successful cross-facial nerve grafting during the first week following their initial surgery. Each received a sural nerve graft to at least two main divisions of the VIIth cranial nerve. We discuss our operative technique and the degree of restored nerve function.