The Best Reanimation Option for Early Stage Facial Paralysis: Triple Nerve Transfers Short-Term Outcomes

Introduction: Facial paralysis is a challenging condition that affects both function and quality of life. Numerous surgical techniques have been described for facial reanimation, including nerve-based reconstruction methods. The choice of the most suitable approach depends on factors such as etiology, duration of paralysis, patient age, residual nerve status, and surgeon preference. Objective: To measure facial movement and symmetry among patients with flaccid facial paralysis who underwent triple nerve transfer surgery, hypothesizing that those receiving this approach will demonstrate improved facial movement and quality-of-life outcomes as measured by Emotrics and FaCE scores. Methods: Twelve patients underwent selective triple nerve transfer surgery in our center. Outcomes were assessed using artificial intelligence–based facial analysis tools and the Facial Clinimetric Evaluation (FaCE) Scale. Results: The mean oral commissure excursion improved from 20.31 ± 5.7 mm preoperatively to 29.79 ± 5.54 mm postoperatively ( p < 0.05). Dental exposure improved from 0.13 ± 0.08 mm to 3.64 ± 1.12 mm ( p < 0.05). The mean FaCE Scale score increased from 34 to 50.3 ( p < 0.05). Conclusion: These findings suggest triple nerve transfer improves voluntary smile symmetry and quality of life in patients with complete facial paralysis.