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Functional Outcomes and Histomorphometric Analysis of Donor Axon Regeneration after Facial Reanimation with Cross-Face Nerve Grafts and Gracilis Muscle Transplants in Pediatric and Adult Facial Palsy Patients
Eva Placheta, M.D., Benedikt Schwaiger, M.D., Igor Pona, M.D., Thomas Rath, M.D., Chieh-Han J. Tzou, M.D..
Medical University of Vienna, Vienna, Austria.

PURPOSE:
Facial reanimation with cross-face nerve grafts is the gold-standard treatment in severe and long-standing cases of facial palsy. We hypothesized that the functional and histomorphometric results after cross-face nerve grafting and gracilis muscle transplantation is superior in the pediatric patient group when compared to adults.
METHODS:
19 pediatric patients (<18 years of age) and 48 adult patients undergoing facial reanimation surgery with cross-face nerve grafts (1st stage surgery) and gracilis muscle transplantation (2nd stage) with postoperative follow-up times of ≥18 months were included in the study. Standardized facial movements were recorded for 3D video analysis preoperatively and postoperatively in all patients. Nerve biopsies were available in 9 pediatric patients (53%) and 13 adults (27%). Descriptive statistical analysis, t-tests and non-parametric tests were performed and correlations (Spearman-Rho coefficient) calculated; alpha was set at 5%.
RESULTS:
3D video analysis showed significant functional improvement 18 months postoperatively in both the pediatric and the adult group. The symmetry of "smiling with showing of the teeth" was significantly higher in pediatric patients. The improvement of eye function failed to show statistically significant differences between groups. The axon count of the facial nerve donor branches and the percentage of axons that reached the distal end of the cross-face nerve graft did not correlate with the patient age and did not significantly differ between the two groups.
CONCLUSION:
Facial function was significantly improved in all patients. The reanimation of the mouth was more symmetrical in pediatric patients, although the axon count did not differ.


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