Cross facial nerve grafting as the first stage of congenital facial palsy treatment in a 5-year-old child: a clinical case

Relevance. Facial palsy is a severe somatic disease that significantly deteriorates the quality of life and affects adaptation in society. Both children and their families bear the burden of treating pediatric facial palsy. Some types of acquired facial nerve neuropathy require conservative treatment. Neuroplasty is a method of treating recently acquired acute facial palsy. The aplasia of the facial nerve and facial muscles, which requires myoneuroplasty in two stages, determines the complexity of the congenital facial palsy treatment. Cross-facial nerve grafting is the first stage of myoneuroplasty. A separate article describes the clinical case due to congenital aplasia of the buccal branch of the right facial nerve and the muscles innervated by it and due to the small number of surgeries performed in Russia in children with congenital facial palsy.

Purpose. We aimed to prepare a 5-year-old child for free revascularized gracilis muscle transfer in the position of the right zygomaticus major muscle to treat a congenital facial palsy.

Materials and methods. The paper describes a clinical case of cross facial nerve grafting by microsurgical techniques in a 5-year-old child with congenital palsy of the right zygomaticus major muscle at the Department of Pediatric Maxillofacial Surgery of the Maxillofacial, Plastic Surgery and Dentistry Clinical Center of A.I. Yevdokimov MSUMD. Results. In the postoperative period, the patient had no complications. Postoperative scars in the maxillofacial area were aesthetically acceptable. Numbness of soft tissues in the leg and foot was insignificant. The final result of the treatment would be after the second stage of treatment, i.e., free revascularized gracilis muscle transfer.

Conclusion. Pediatric cross-facial nerve grafting is a technically advanced surgery. The surgery does not have anthropometric contraindications for a 5-year-old. The use of a microscope and intraoperative neuromonitoring are recommended.

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