36 year old female healthy patient, with facial paralysis on the left side since 16 months because of Ramsay-Hunt infection.
There is hardly any recovery with few synkinesis (eye and corner of mouth). In the rest situation there is fair symmetry (Figure 1), but she still can barely move the corner of the mouth while smiling (Figure 2). House Brackman is classified as 5, and Sunnybrook 32.
I consider the following surgery: Cross-over sural nerve (from the right sided nVII) connected to a left Zygomatic branch (nVII), and Masseteric nerve (nV) connected to the left Buccal branch (nVII). This way I hope to create strength in the facial muscles in a short time (3-4 months) with the Masseteric nerve, while waiting on spontaneous smile after ingrowth of the cross-over nerve fibers.
Does the international panel agree with this surgical plan (I have never performed this type of surgery in this pathology) and is it not too late to expect a successful outcome?