Facial Reanimation in Face Transplantation

Face transplantation is a life-transforming surgery for patients with complex and devastating facial injuries who have exhausted the traditional armamentarium of plastic surgery. The ultimate success of this procedure is dependent upon the regeneration of the recipient’s facial nerves into donor tissue, restoring the complex movement of facial musculature to enable optimal results. Goals of facial reanimation in face transplant are similar to those in facial paralysis; dependent on the recipient defect, these include spontaneous smile, ability to blink, restoration of oral commissure integrity, and capacity to show facial expression. These goals can be reached through careful preoperative assessment of donor and recipient facial nerve function and intraoperative nerve mapping of donor and recipient nerve branches. We also advocate for distal nerve branch coaptation to reduce potential aberrant reinnervation and synkinesis and to shorten the distance required for regeneration to target muscles. We also recognize the need for standardized assessment of facial nerve motor function among face transplant patients to further improve outcomes in this innovative field. Face transplant success and patient satisfaction with postoperative quality of life is largely dependent upon the degree of nerve regeneration and reanimation. Thus, careful assessment of this aspect of the procedure is paramount.