Variations on the "baby-sitter" procedure for reconstruction of facial paralysis.

Four cases of fresh facial paralysis were treated using the "baby-sitter" procedure, with fairly satisfactory results obtained. This procedure involves a combination of cross-face nerve grafting and a nerve cross-over technique such as using a hypoglossal-facial nerve or accessory-facial nerve anastomosis. Two stages are required. Nerve cross-over and cross-face nerve grafting using the sural nerve are performed in the first stage. After 1 year nerve anastomosis between the stump of the cross-face nerve graft and that of a buccal branch in the paralyzed cheek is performed during the second stage. The recovery of facial animation through this method is good, with patients able to create a near-natural smile. Electromyography demonstrates double innervation in the paralyzed cheek area.