Original ArticlesCross-Facial Nerve Grafting as an Adjunct to Hypoglossal-Facial Nerve Crossover in Reanimation of Early Facial Paralysis: Clinical and Electrophysiological EvaluationYoleri, Levent MD*; Songür, Ecmel MD†; Mavioğlu, Hatice MD‡; Yoleri, Özlem MD§Author Information Departments of *Plastic and Reconstructive Surgery and ‡Neurology, Celal Bayar University Medical School, Manisa; the †Department of Plastic and Reconstructive Surgery, Ege University Medical School, İzmir; and the §Department of Physical Medicine and Rehabilitation, Atatürk Training Hospital, İzmir, Turkey. Received May 30, 2000, revised form Sep 26, 2000. Accepted for publication Sep 26, 2000. Address correspondence and reprint requests to Dr Yoleri, Inönü Cad. 697/30, 35290 İzmir, Turkey. Annals of Plastic Surgery: March 2001 - Volume 46 - Issue 3 - p 301-307 Buy Abstract Reanimation of a spontaneous and synchronous smile, and sufficient depressor mechanism of the lower lip presents a surgical challenge in facial paralysis. Hypoglossal-facial nerve crossover and cross-facial nerve grafting are the best options if the mimetic muscles around the mouth are still viable in patients in whom the facial nerve was sacrificed at the brainstem. Although good muscle tone and facial motion have been obtained by hypoglossal-facial nerve crossover, smile is dependent on conscious tongue movement. Cross-facial nerve grafting provides a voluntary and emotion-driven smile, but requires two coaptation sites, which leads to substantial axonal loss and a long regeneration time. This method was not successful in activating the depressor mechanism. The first stage is the classic “baby-sitting” procedure, in which the bulk of the mimetic muscles was maintained by the rapid reinnervation of the hypoglossal-facial nerve crossover during the regeneration period of the cross-facial nerve graft, and temporalis muscle transfer to the eyelids is performed. During the second stage, the cross-facial nerve graft that used the thickest zygomaticobuccal branch on the healthy side was coapted with the corresponding branches on the paralyzed side. The hypoglossal-facial nerve crossover continued to innervate the depressor muscles. Good spontaneous smile and sufficient depressor mechanism were achieved by cross-facial nerve grafting and hypoglossal-facial nerve crossover respectively, and these techniques are demonstrated by the authors clinically and electrophysiologically. © 2001 Lippincott Williams & Wilkins, Inc.