Definition & Overview

A graft for facial nerve paralysis is a medical procedure wherein a piece of nerve is taken from one part of the body and transplanted into the face. It is used to repair or replace damaged facial nerves that cause facial paralysis. The goal of the procedure is to restore feeling and movement to the face. The prognosis for patients who undergo the procedure is good, with most of them experiencing an improvement within a few months.

Who Should Undergo and Expected Results

A facial nerve graft is used to treat patients who suffer from facial paralysis, a medical condition wherein a person is unable to move the features of his face. It is often caused by damage to the facial nerves, which can occur due to injury or disease.

Some of the diseases that cause facial paralysis include:

  • Bell’s palsy
  • Lyme disease
  • Bacterial infection
  • Inflammation of the facial nerve
  • Facial tumour

Patients who suffer from facial nerve paralysis are encouraged to seek treatment at the soonest possible time. This is because the condition can impair their ability to communicate and display facial expressions. Studies show that it also has significant psychological effects.

Facial paralysis can be classified as mild, moderate, severe, or complete. The severity of the condition depends on how many nerves are affected and where they are connected. Facial nerves are connected to a total of 23-paired muscles, 18 of which are responsible for producing facial expressions.

  • Mild - The patient’s face looks normal and balanced when he is not moving it. He can move his forehead and close his eyes without extra effort. However, there is a slight weakness when he tries to move his face. His mouth may also be slightly uneven.

  • Moderate – The patient’s face is clearly uneven. The patient also has to use more effort to move his forehead, mouth, and eyes.

  • Severe – The patient can hardly move his face. He also cannot move his forehead or fully close his eyes, and can only move his mouth slightly.

  • Total paralysis – The patient cannot move his face at all.

Several factors can affect the results of a nerve graft surgery. These include:

  • The patient’s age
  • The length of the nerve graft
  • The length of time between the onset of the paralysis and the procedure

Studies show that of all these factors, the most influential is the length of time between the facial nerve injury and the grafting surgery. This means that early detection is important and that the surgery should be performed soon after the patient’s face became paralysed. Doing so will improve their chances of a successful operation. In fact, a patient who has been paralysed for less than 18-24 months has more treatment options than those who have been paralysed for a longer period.

Facial nerve grafting is one of the most effective treatments for facial nerve paralysis. The nerve graft works by connecting the healthy nerves on both sides of the face. This way, nerve signals can pass through them again. This is why the graft is called a “cross face nerve graft”.

How is the Procedure Performed?

Before the procedure, doctors first diagnose and assess the severity of the condition with the help of some tests. During the tests, they ask patients to do basic facial movements, such as:

  • Wrinkling the forehead
  • Eye closure
  • Whistling
  • Blowing
  • Smiling widely

They also compare the symmetry of the patient’s face at rest and when they are smiling. In addition, they observe the patient’s voluntary and spontaneous facial movements. On certain occasions, patients may also be advised to undergo computed tomography (CT) and magnetic resonance imaging (MRI) scans.

The surgery involves the following steps:

  • The patient is placed under general anaesthesia. This means he is asleep during the entire surgery.
  • The surgeon takes a nerve graft from another part of the body. The two most commonly used nerves are the great auricular nerve and the sural nerve. The great auricular nerve is easy to harvest because it is located near the face and is a good match in terms of size. However, only 7-10 cm can be harvested from this nerve. When a longer nerve graft is needed, doctors use the sural nerve harvested from the posterior lower leg. Doctors can harvest up to 35cm of the sural nerve. This length is quite useful for cross-face grafting.
  • The surgeon implants the graft into the patient’s face.
  • The patient has to stay in the hospital for 1 to 2 days.

After the surgery, the nerves will begin to heal slowly. However, patients may have to wait around 9 to 12 months before they can feel its full effects. Patients may be advised to undergo physical therapy following the procedure to help them regain control of their various facial regions.

Possible Risks and Complications

Patients who undergo a facial nerve grafting are at risk of:

  • Bleeding
  • Hematoma
  • Infection
  • Scarring
  • Leaking saliva
  • Damage to nearby nerves


  • Ozmen OA, Falcioni M, Lauda L, Sanna M. “Outcome s of facial nerve grafting in 155 cases: predictive value of history and preoperative function.” Otol Neurotol. 2011 Oct; 32(8): 1341-6.

  • Volk GF, Pantel M, Guntinas-Lichius O. “Modern concepts in facial nerve reconstruction.” Head Face Med. 2010; 6:25.

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