Global survey reveals age- and etiology-dependent donor nerve choices in long-standing facial paralysis, highlighting the need for clinical consensus.
Key Points
Evaluate global microsurgical preferences and decision-making patterns for donor nerve selection during functioning free muscle transplantation in long-standing facial paralysis.
Distributed an international, web-based questionnaire with ten standardized clinical scenarios to attending microsurgeons performing functioning free muscle transplantation.
Surveyed 107 experts across 34 countries to capture demographic information, technical preferences, and adjunctive strategies, analyzing data with descriptive statistics.
The gracilis was the preferred donor muscle (92.5%), with cross-facial nerve grafts favored in patients aged <60 years (44.9%) and the masseteric nerve predominating in patients aged ≥60 years (60.7%).
The masseteric nerve was selected by 91.6% of surgeons for bilateral congenital paralysis, whereas unilateral developmental cases were split among cross-facial nerve grafts (35.5%), masseteric nerve (34.6%), and dual innervation (26.2%).
Surgeons prioritized either maximal excursion (42.1%) or spontaneous smile (39.3%), while adjunctive techniques included sensory supercharging (21.5%), electrical stimulation (14.0%), and vascularized nerve grafts (7.5%).