Cross face nerve grafting for reinnervation of nasal and tongue mucosa following trigeminal nerve injury

Central injury to the trigeminal pathways can cause debilitating facial anesthesia, mucosal anesthesia, taste alteration and neurotrophic keratopathy, leading patients and physicians to seek treatments for these deficits. A patient presented with complete left hemifacial anesthesia and recurrent epistaxis following resection of a left posterior fossa astrocytoma. She subsequently was treated with cross-face nerve grafting using input from the contralateral unaffected trigeminal nerve branches to provide sensation to the hemitongue, nasal mucosa, cornea, and the V2 and V3 dermatomes. WEST facial set Semmes-Weinstein Monofilament testing was performed pre-operatively and at 4, 13, 18 and 24 months post-operatively, along with subjective light-touch evaluation of the nasal septum and tongue. By 3 months the patient reported subjective early signs of sensation to the tongue, teeth, buccal mucosa, and cornea but no changes in cutaneous sensation. Cutaneous sensation was returning by her 5-month post-operative review, with no subjective or objectively measurable deficit in any contralateral donor nerve distributions. Her cutaneous and mucosal sensation improved postoperatively. The cycle of recurrent epistaxis was halted. Our findings shows that deficits in hemitongue and nasal mucosal afferent innervation may be reconstructed using cross-face nerve grafts. Such procedures may be combined to address multiple deficits simultaneously.