Does Timing Between Procedures Affect Facial Reanimation Outcomes in Dual versus Single Nerve Transfer?
Cynthia T. Yusuf*, Christopher Lopez, Robin Yang, Richard Redett
Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD
Cross-facial nerve graft (CFNG) in conjunction with free functional muscle transfer (FFMT) has become the standard of treatment for facial paralysis. The question on whether dual transfer techniques and timing between both procedures lead to better patient outcomes remains unanswered. As such, a comparative analysis is warranted to compare time to first facial movement and time to spontaneous smile.
A retrospective study of patients who underwent both a CFNG and gracilis FFMT at single institution was performed from 2016 to 2023. Predictor variables included race, ethnicity, age, time between CFNG and gracilis, dual nerve transfer, surgical service, and baseline paralysis score. Primary outcomes were time to first facial movement and spontaneous smile. Multiple linear regressions were performed (alpha <0.05).
This study included thirty-one patients who had both a CFNG and FFMT procedure. Between single and dual transfer patient cohorts, there was no difference to time to first facial movement and time to spontaneous smile. Multiple linear regression has shown that the predictor variables (time between CFNG and gracilis FFMT, race, dual vs. single nerve transfer, age at CFNG, and level of paralysis) also did not significantly predict time to both outcomes. However baseline paralysis score [(first facial movement): β: -0.872, p = 0.053; (spontaneous smile): β: -0.440, p = 0.053] neared significance for prediction of both outcomes.
Single vs. dual nerve transfer and timing between CFNG and gracilis FFMT did not lead to differences in time to facial movement and spontaneous smile. This lack of novel disparities between our studied predictor variables and achievement of smile elucidates that any delay between gracilis FFMT and CFNG does not preclude patients from attaining timely and successful smile rehabilitation. This is critical in the paradigm of general preoperative planning with respect to establishing a reasonable recovery timeline.
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