Sensory Reinnervation for Hemifacial Anesthesia using Contralateral Nerve Transfers via Side-to-End Cross-Face Sural Nerve Grafts: A New Approach to a Difficult Problem
Gregory H. Borschel, MD, FACS, FAAP, Catapano Joseph, MD, David Scholl, BA, Ronald M. Zuker, MD, Siba Haykal, MD, Emily S. Ho, MSc, OT, Cecilia Jobst, MSc, Douglas O. Cheyne, PhD.
The Hospital for Sick Children, Toronto, ON, Canada.
Hemifacial anesthesia may arise after CNS tumor resection, trauma, or other causes. Reconstruction for hemifacial anesthesia has not been previously described. We present a novel method of reinnervating insensate hemifaces.
We exposed the insensate infraorbital and mental nerves, and the contralateral intact donor nerves, through separate upper and lower buccal sulcus incisions. We tunneled cross-face sural nerve grafts submucosally between the incisions. We performed side-to-end coaptations from the donor nerves to the grafts. We coapted the distal ends of the grafts end-to-end to the denervated recipient branches. We measured sensory function pre- and postoperatively using standard Semmes-Weinstein monofilaments. Functional Magnetic Resonance Imaging (fMRI) and Magnetoencephalography (MEG) were used to study central remapping.
Six nerves in three patients (age range 16 - 35) underwent nerve grafting, all of which developed protective sensation or better by one year postoperatively, except for one infraorbital nerve in one patient who had sustained a severe traumatic brain injury previously. Some of the treated nerves regained a normal or near-normal level of tactile sensation as measured by monofilaments. Surgery did not worsen donor nerve sensory function postoperatively as measured by monofilaments. MEG/fMRI studies illustrated brain changes underlying the central mechanisms involved in neuroplasticity following nerve transfer.
Sensory cross face nerve grafting is effective in addressing hemifacial anesthesia. The technique may be extended to address longstanding denervation for isolated trigeminal nerve branches as well.
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