We present the surgical techniques and results of cross-facial nerve grafting that have been developed in the repair of ocular-oral synkinesis after facial paralysis. Eleven patients with ocular-oral synkinesis after facial paralysis underwent the cross-facial nerve grafting with facial nerve transposition at a tertiary academic hospital between 2003 and 2009. The patient selection for the study was based on the degree of disfigurement and facial function parameter rating using the Toronto Facial Grading System. The procedures used were surgeries done in two stages. All cases were followed up for 2 months to 6 years after the second surgery. The degree of improvement was evaluated at 6 to 7 months after the procedures. Six of the patients were followed up for more than 2 years after the stage-two surgery and demonstrated significant reduction in the ocular-oral synkinetic movements. The Toronto Facial Grading System scores from the postoperative follow-ups increased an average of 16 points (28%), and the patients had achieved symmetrical facial movement. We concluded that cross-facial nerve grafting with facial nerve branch transposition is effective and can be considered as an option for the repair of ocular-oral synkinesis after facial paralysis in select patients.
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