Cross-face nerve graft with free-muscle transfer for reanimation of the paralyzed face: a comparative study of the single-stage and two-stage procedures.

The most accepted method for reanimation of the paralyzed face is the two-stage method that combines cross-face nerve graft with free-muscle transfer. Although the results of reconstruction with this method are satisfactory, there is an excessive delay between stages, which prolongs the period of rehabilitation. In 1995, Kumar overcame this and presented his preliminary results from a single-stage transfer of the gracilis. We compared the long-term results of the single-stage with the two-stage method of reconstruction. Patients selected the method of reconstruction on the basis of the information, photographs of scars, and video recording of results given to them at a special facial palsy clinic. Ten patients selected the single-stage reconstruction and 15 selected the two-stage reconstruction. The mean follow-up period was 3 years. The results of the two methods are comparable, with 90 percent of the patients who underwent the single-stage and 93 percent of those who underwent the two-stage procedures having good and fair results. However, the two-stage method scored good symmetry at rest in 67 percent, compared with 20 percent for the single-stage method. There were fewer complications with the single-stage method, and none of the patients had any problems relating to the donor site. The period of rehabilitation was reduced by 10 months with the single-stage method.