Original ArticlesSurgical Optimization of Motor Recovery in Face TransplantationAycart, Mario A. MD; Perry, Bridget MS; Alhefzi, Muayyad MD; Bueno, Ericka M. PhD; Kueckelhaus, Maximilian MD; Fischer, Sebastian MD; Pomahac, Bohdan MDAuthor Information *Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA †Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum ‡Department of Plastic Surgery, BG University Hospital Ludwigshafen, Heidelberg University, Ludwigshafen, Germany. Address correspondence and reprint requests to Bohdan Pomahac, MD, Associate Professor of Surgery, Harvard Medical School, Director of Plastic Surgery Transplantation and Burn Center, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115; E-mail: email@example.com Received 29 June, 2015 Accepted 28 September, 2015 Drs BP, EMB, MK, and SF receive partial salary support from a research contract with the United States Department of Defense (#W911QY-09-C-0216). The authors report no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.jcraniofacialsurgery.com). Journal of Craniofacial Surgery: March 2016 - Volume 27 - Issue 2 - p 286-292 doi: 10.1097/SCS.0000000000002305 Buy SDC Metrics Abstract Background: Face transplantation (FT) has emerged as a viable option for treating devastating facial injuries. Most reported outcomes have demonstrated satisfactory motor and sensory restoration despite differences in technique. The authors have developed an algorithm of facial nerve management in these challenging patients. Our principles of management are illustrated by 2 specific patients. Methods: A retrospective analysis of prospectively collected data on 2 full face transplants was performed. Both patients required nerve grafting during full FT. Patient 1 due to short donor facial nerve stumps and patient 2 due to intraoperative soft tissue swelling. Patient 2 required a nerve transfer 11 months after full FT due to impaired motor recovery opposite the side of nerve grafting. Follow-up examinations consisting of manual muscle testing and Sunnybrook Facial Grading System 6 to 42 months after full FT with selected video examinations were critically reviewed. Results: Patient 1 had symmetrical motor recovery with gradual improvements noted throughout. At 6 months, Patient 2 had asymmetrically improving motor function. After nerve transfer, the patient showed gradual improvement in motor recovery, symmetry, and tone. Videos for each patient demonstrate the evolution of the patients’ ability to smile from 6 to 42 months. Discussion: The authors describe their assessment of motor recovery and management of facial nerve reconstruction as it pertains to FT. Finally, the authors illustrate the principles of nerve transfer are applicable to FT recipients. © 2016 by Mutaz B. Habal, MD.