Comparative Analysis of End-to-End versus End-to-Side Neurorrhaphy for the upper crossface in the second surgical step of triple innervation technique for Facial Reanimation Surgery: A Retrospective Study

Facial paralysis poses significant challenges including functional impairments and aesthetic anomalies. The management of facial palsy often involves many surgeries aimed at reanimating the facial muscles and restoring protective mechanisms such as the blink reflex. In recent years, the triple innervation technique has emerged as a promising approach for facial reanimation, combining multiple neural inputs to achieve functional restoration. This retrospective study compares the outcomes of two different neurorrhaphy techniques, namely end-to-end and end-to-side, in the context of the upper cross-face nerve graft during the second surgical step of the triple innervation technique for facial reanimation surgery. Thirty patients with unilateral complete facial paralysis were included in the study, and outcomes were evaluated based on pre- and post-operative assessments including electromyography, eFACE scores, and blink reflex evaluations. Results indicate significant improvement in static facial symmetry, voluntary movements, and blink reflex in both groups postoperatively. However, a comparison between the two groups revealed better outcomes in terms of gentle eye closure in the end-to-side neurorrhaphy group, while no differences in term of post-operative synkinesis were described. This suggests that preserving the reinnervating nerve fibers of the masseteric nerve through end-to-side neurorrhaphy may optimize functional outcomes of the reanimated orbicularis oculi muscle.