Incomplete facial paralysis - The use of the ipsilateral residual facial nerve as a donor nerve for facial reanimation.

Background: The reconstructive approach for incomplete facial paralysis is not yet determined. In this article we present a new surgical approach for patients with incomplete facial paralysis in which residual, ineffective movement is detected pre-operatively in the ipsilateral bucco-zygomatic territory of the paretic facial nerve. Methods: Sixteen patients with incomplete facial paralysis were found eligible for the procedure and underwent one-stage facial reanimation by the senior author (E.G.). Reanimation was performed using free gracilis muscle transfer with neural coaptation to an active facial nerve branch/es responsible for the pre-detected bucco-zygomatic residual movement. Patients were reviewed in a systematic fashion using a combined still photo and video scoring scale for symmetry at rest and at dynamic states. Results: Following surgery, improved symmetry was observed in the majority of observations of the mouth region at rest and while smiling and nasolabial fold region while smiling. There was no significant change in symmetry in the majority of observations of the eye region at rest and while smiling and nasolabial fold region at rest. Video assessment of dynamic facial symmetry while smiling demonstrated improved symmetry in 91% of the observations (n=191 observations). Comparison of mean scores for dynamic smile symmetry produced a statistically significant improvement of 1.68 points following surgery (p