Toward shortening interoperation period in two-stage cross facial nerve graft with muscle transfer

Cross facial nerve graft with free muscle transfer is a well-accepted method to deal with the long-standing facial paralysis, which is usually carried out in 2 separate operations including the nerve graft in first operation followed by a muscle transfer 10 to 12 months later. However, delayed rehabilitation of the nerve graft because of its long length leads to considerable interval between first and second operations. Nine patients with long-standing unilateral facial paralysis underwent 2-stage cross facial nerve graft with some modifications in techniques. In this new technique, by placing the end of the nerve graft in nasolabial fold in the first stage, we used shorter nerve grafts and reduced the interval between operations from 3.5 to 5 months. We believe that by using shorter nerve grafts in this technique, we can perform second-stage operation pretty earlier, and placing the end of nerve graft in nasolabial fold reduces the risk of nerve graft traumatization in preauricular dissection during the second stage.