Nerve transfers are typically indicated for patients with flaccid facial paralysis in order to restore static facial tone or dynamic movement. The goal of a nerve transfer is to recruit an alternative source of neurons and re-route them toward the paralyzed side of the face in order to restore function.
A 5-7 nerve transfer routes neurons from the masseteric nerve, or the “chewing” nerve, to the paralyzed face in order to restore dynamic smile function.
A 12-7 nerve transfer routes neurons from the hypoglossal nerve, or the “tongue” nerve, to the paralyzed face in order to restore natural, resting facial tone.
A cross-facial nerve graft (CFNG) routes neurons from the facial nerve on the unaffected side of the face to the paralyzed face, in order to strengthen the smile or prepare for a gracilis free muscle transfer.
What to expect during nerve transfer surgery?
These procedures are performed under general anesthesia in the operating room. On the day of surgery, you will have a chance to meet with Dr. Yver to ask any questions and sign the necessary paperwork. The surgery may last 2 – 8 hours, depending on the number and type of nerve transfers being performed. Sometimes a small nerve graft may be borrowed from the region of the ankle or neck. Following a 5-7 nerve transfer or CFNG, you will be discharged home after the surgery. Patients typically spend one night in the hospital following a 12-7 nerve transfer. You will need somebody to drive you to and from the hospital.
What can I expect after surgery?
After surgery, you will be asked to keep your face and leg wrapped for 72 hours. After 72 hours, these dressing may be removed and you can shower as normal. You will be provided with antibiotic ointment to apply to the sutures. Some facial swelling or minor bruising may be observed for two weeks after surgery. Patients are encouraged to apply ice for 48 hours after the procedure and to sleep with the head propped up on several pillows, in order to minimize swelling. The stitches may take 10-14 days to fully dissolve. Patients are encouraged to avoid any exercise, heavy lifting, or strenuous physical activity for two weeks after surgery, or until they are cleared at their post-operative visit.
Patients often ask if they will have any negative side effects from “borrowing” neurons from a different source. Due to the natural redundancy of facial innervation, patients do not typically experience any difficulty speaking, chewing, moving their tongue, or changes to facial function on the unaffected side. If a nerve graft is borrowed from the ankle or neck, patients may experience a small amount of permanent numbness in that area, although there is no functional sequelae from this and patients are able to maintain their normal activity level.
When will I see results?
Results are not seen immediately after nerve transfer surgery, as it takes time for the nerves to regenerate. Final results may be seen between 3 months – 1 year following nerve transfer surgery, depending on the type of transfer performed.
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