Facial reanimation. (Letters to the Editor).

Editor:

I have enjoyed reading the article, "Facial reanimation by cross-facial nerve grafting: Report of five cases," by Galli, Valauri, and Komisar, which appeared in the January 2002 issue of EAR, NOSE & THROAT JOURNAL. I congratulate the authors for their proficient work and results.

The concept of the anastomosis between the two facial nerves, in cases of facial nerve paralysis in which the nerve trunk is not accessible proximal to the site of the injury, remains as sound today as it was when first presented as a preliminary report at the Second International Symposium on Facial Nerve Surgery held in Osaka, Japan, September 27-3 0, 1970. (You and I both attended that meeting.)

Return of normal function on the paralyzed site of the face cannot be achieved regardless of the surgical technique used, once the facial nerve trunk has been severed. Furthermore, ancillary techniques of plastic surgery to aid in protecting the affected eye and/or in improving a drooping eyebrow, etc., might be needed in some cases.

Utilizing the entire lower division of the normal facial nerve as a donor nerve in my cases and experience has not left discernible deficits on the donor site of the face. In fact, the donor site has remained preponderant.

The classic paper of Davis and coworkers (Davis RA, et al. Surgical Anatomy of the Facial Nerve and Parotid Gland based on a study of 350 cervico-facial halves. Surgery Gyn-Obstetrics 1956; p. 102-14) showing the relationships among the branches of the pes anserinus was one of the factors in my conceptualizing and performing the anastomosis between the two facial nerves.

I again congratulate the authors on their fine presentation and you for your continued genuine interest in facial nerve problems and study, and for bringing to the fore the above concept once again.

Louis F. Scaramella, MD

Century Ear, Nose and Throat

Head and Neck Surgery

Orland Park, Illinois 

Response:

We were pleased to read Dr. Scaramella's comments, as he was the original surgeon to develop this technique in the 1970s. He reminds us that no technique can restore facial function completely and that, often, adjunct procedures are necessary for target deficits in some patients.

Dr. Scaramella accomplished this method using the entire lower division of the donor facial nerve, and he reports that none of his patients developed any postoperative weakness on the donor side. In our technique, donor nerves were dissected and evaluated with a nerve monitor so that only secondary branches were used as donor branches. Using this cautious tactic, postoperative weakness on the donor side was avoided in our series.

From a conceptual standpoint, cross-facial nerve grafting makes sense and remains an elegant option in the armament of facial reanimation. We thank Dr. Scaramella for his comments.

Suzanne K. Doud Gaul, MD, PhD

Department of Otolaryngology

New York University 

New York, New York