18 month old female born with right facial paralysis and vascular brainstem tumor. Now doing well after complicated post-resection medical course (trach, vent-dependence, etc). The question is whether she is a candidate for long cross face nerve grafts to smile and eye, and if people have done this in this age group, delayed hookup or primary hookup on paralyzed side? I believe she has normal facial nerve anatomy, but the vascular tumor shut down input from the facial motor nucleus pre-natally. Would cross face grafts even reach? (She is nomral size for 18 month old). Any input welcome!!
Or do we just wait and do two stage gracilis when a little bigger? Or babysit with ohter nerves? Swallowing and speech delays so would not consider hypoglossal (currently g-tub edependent but working on oromotor skills).