Epta-innervation for facial reanimation: seven donor nerves to extremize the concept of multiple innervation and supercharging

Surgical ‘restitutio ad integrum’ after facial palsy remains a fantasy. Facial reanimation for recent permanent paralyses — those where muscles still fibrillate on EMG — is based on new neural input. Among these cases, while static symmetry is frequently addressed, the whole spectrum of mimetic movements remains limited and never equal to the healthy side. A new technique is proposed, based on utilizing seven donor nerves, with the aim to improve neglected movements and minimize asymmetry during talking and mimetic expressions. Donor nerves are harvested and utilized according to their proven best yield for facial reanimation. Our study reviewed 15 patients affected by recent unilateral facial palsy, and who underwent this new technique. They had a minimum follow-up of 12 months, and pre- and postoperative assessment via the e-FACE grading system was performed for each patient. The preliminary results seem to be encouraging, but extensive cases series will be needed to obtain more significant data and guide future technical corrections. This would be the only way to edge towards future ‘restitutio ad integrum’ of face morphology and function, which remains the ultimate desire of these unfortunate patients.