Combination of Cross-Face Nerve Grafting and Masseteric Nerve Transfer in the Treatment of Incomplete Facial Paralysis: A Contemporary Systematic Review.

INTRODUCTION

Incomplete facial paralysis (IFP) poses a clinical challenge due to its heterogeneous etiologies and unpredictable outcomes. While treatment for complete paralysis is well established, effective interventions for IFP remain limited. Recently, combining cross-face nerve grafting (CFNG) with masseter nerve transposition (MNT) has emerged as a promising surgical strategy, aiming to provide both strong motor input and spontaneous facial movement in these patients.

METHODS

A systematic review of PubMed and Medscape (2021-2025) was conducted following PRISMA guidelines. Studies were included if they reported clinical outcomes of combined CFNG and MNT in patients with IFP.

RESULTS

Three studies met the inclusion criteria, comprising 48 patients. Bell's palsy was the most frequent etiology, followed by trauma and postsurgical injuries. Biglioli et al provided the only individual-level outcome data, showing postoperative improvement across etiologies and no significant correlation between age and dynamic recovery-findings consistent with larger cohorts, in which age-related trends do not reach significance. Outcome comparison across studies was limited by heterogeneous assessment tools. A clear trend toward end-to-side neurorrhaphy was observed in recent literature, reflecting a shift toward preserving residual motor fibers.

CONCLUSIONS

Despite heterogeneity in surgical techniques and outcome assessments, CFNG combined with MNT consistently yielded favorable results. The approach described by Morley, involving end-to-side neurorrhaphy, may offer particular advantages by preserving healthy neural pathways and enhancing functional outcomes. While current evidence supports the effectiveness of dual innervation, standardized evaluation methods and larger patient cohorts are essential to validate these findings and guide individualized treatment strategies.