April 2020 HSC Section 4 - Plastic and Reconstructive Problems

Joseph & Kim

surgery. 29 Furthermore, an additional benefit to the dual innervation technique was the minimal reported synkinesis, which is not often the case when cable grafts are used for multiple facial nerve branches. Similar results had been previously described by Volk and colleagues 30 with the hypoglossal nerve and a cable graft. Dual innervation or polyinnervation procedures may be accomplished in many ways. Hypoglossal nerve transfer is well-recognized to provide good resting tone, although the smile is not as natural as with transfer of other donor cranial nerves, such as the masseteric nerve or CFNG. The hypoglossal and masseteric nerves may be used in a scenario in which the hypoglossal nerve contributes to good resting Fig. 3. Common schemes used to provide dual innervation. ( A ) Facial nerve interposition nerve graft combined with masseteric to buccal branch nerve transposition. ( B ) Partial hypo- glossal to facial nerve transposition via interposition graft combined with masseteric nerve to buccal nerve branch transposition. ( C ) Partial hypoglossal to facial nerve transposition via interposition graft combined with CFNG to buccal nerve branch transposition. Cross-facial sural, cross-face sural nerve graft; Facial, facial nerve; MAB, median antebrachial cutaneous nerve; Masseteric, masseteric nerve.

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