Ansa Cervicalis to Marginal Mandibular Nerve Transfer, a Feasible Option to Improve Lower Lip Function in Facial Nerve Paralysis.

Facial nerve palsy affecting the lower face may compromise essential functions such as speech and eating. The associated facial asymmetry can contribute to social isolation. Facial nerve reconstruction using a combination of interposition nerve grafts and/or nerve transfers offers significant improvement. However, these options are limited by insufficient donor nerves and unwanted synkinesis if a single donor nerve is used for the entire hemi-face. To ameliorate both limitations, we perform an ansa cervicalis to marginal mandibular nerve transfer to restore tone and symmetry to the lower third of the face. We have found this a safe and feasible technique with minimal donor site morbidity. The anatomy is favorable both in terms of donor nerve length and size match between nerves. We report 9 cases with at least 6 months follow up which demonstrate improved lower lip tone and symmetry and improved oral competence. Early donor site morbidity and postoperative complications are minimal. This method is a reliable adjunct in facial nerve reconstruction to address the marginal mandibular nerve paralysis.