Eyelid reanimation using crossface nerve graft: Relationship between surgical outcome and preoperative paralysis duration

• Published in: Microsurgery Vol. 38; no. 4; pp. 375 - 380
• Main Authors: Okochi, Masayuki, Okochi, Hiromi, Asai, Emiko, Sakaba, Takao, Ueda, Kazuki
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.05.2018
• Subjects: Adolescent; Adult; Age factors; Atrophy; Child; Cohort Studies; Eye; Eyelid; Eyelids - innervation; Eyelids - physiopathology; Facial Muscles - innervation; Facial paralysis; Facial Paralysis - etiology; Facial Paralysis - physiopathology; Facial Paralysis - surgery; Female; Grafting; Humans; Male; Microsurgery; Middle Aged; Muscles; Nerve Transfer - methods; Paralysis; Patients; Sex; Skin & tissue grafts; Statistical analysis; Sural nerve; Sural Nerve - transplantation; Surgery; Trauma; Treatment Outcome; Young Adult
• ISSN: 0738-1085; 1098-2752
• DOI: 10.1002/micr.30264

Background To reanimate the mimetic muscles, crossface nerve graft (CFNG) is an effective surgical option. However, muscle atrophy after facial paralysis may influence the surgical result. We analyzed the relationship between surgical result and preoperative paralysis duration. Methods We performed CFNG on 15 patients. The sural nerve was transferred between the affected and nonaffected sides of the zygomatic branch. Eyelid function and eyelid lid were evaluated using the modified House–Brackmann scale. The effects of age, sex, cause of facial paralysis, graft nerve length, and preoperative paralysis duration were evaluated. Results The mean follow up period was 9.3 ± 3.3 (range 4–14) years. Eyelid closure was excellent in four patients, good in six, fair in one, and poor in four. Statistically, no significant difference was observed between those patients with excellent or good outcomes and fair or poor outcomes regarding age (40.9 ± 11.0 years vs. 22.6 ± 20.8; P = .067), sex (male/female = 2/8 vs. 3/2; P = .250), cause (tumor/trauma = 10/0 vs. 3/2; P = .095), and length of nerve graft (14.4 ± 0.8 cm vs. 13.8 ± 1.6 cm; P = .375). The average preoperative paralysis duration in the excellent/good patients was significantly shorter than that in the fair/poor patients (P = .005). All eight cases with preoperative paralysis of less than 6 months showed a marked excellent/good result. Two of the seven patients with preoperative paralysis was 6 months or longer marked fair/poor result. (P = .007). Conclusions To achieve successful results with CFNG, surgery should be performed within 6 months of the onset of paralysis.