{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T19:33:25Z","timestamp":1774726405864,"version":"3.50.1"},"reference-count":27,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2024,8,17]],"date-time":"2024-08-17T00:00:00Z","timestamp":1723852800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Anatomy"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>While it has been over half a century since primary cross\u2010facial nerve grafting was first described for facial reanimation, the outcome of this procedure, remains inconsistent and provide lesser smile excursion when compared to the likes of the masseteric nerve. However, the latter itself has limitations in terms of the lack of spontaneity and resting tone. While combinations have been attempted more proximally, we ask the question as to whether more distal nerve transfers with vascularized nerve grafts are a better option. In a retrospective review of clinical practice at our institute, 16 consecutive patients had single, double, and finally triple distal nerve transfers, close to the target facial muscle to reinnervate the motor endplates directly, over a 6\u2010year period (2018\u201323). All patients had the onset of facial palsy within 18\u2009months. Statistical analysis of the comparison between three sub\u2010cohorts was performed using student's <jats:italic>t<\/jats:italic>\u2010test and one\u2010way ANOVA, respectively. Qualitatively, masseteric neurotization of a single facial nerve branch translated into smile improvement in 50% of cases, as opposed to all cases of double\u2010 and triple\u2010neurotization of the smile muscles. In terms of upper lip elevation, single neurotization showed improvement in 25% of cases, double\u2010neurotization in 40% of cases and triple\u2010neurotization in 100% of cases. Upper lip elevation was also significantly better in those who had a vascularized cross\u2010facial nerve graft (Student's <jats:italic>t<\/jats:italic>\u2010test &lt;0.05). In summary, increasing neural input to the motor endplates of smile muscles can significantly improve smile activation, in acute flaccid facial palsies.<\/jats:p>","DOI":"10.1002\/ca.24216","type":"journal-article","created":{"date-parts":[[2024,8,17]],"date-time":"2024-08-17T14:15:05Z","timestamp":1723904105000},"page":"808-814","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The effect of increasing motor end\u2010plate innervation on smile activation in acute and early facial palsy"],"prefix":"10.1002","volume":"37","author":[{"given":"Lucia","family":"Pannuto","sequence":"first","affiliation":[{"name":"Facial Palsy Unit Queen Victoria Hospital  East Grinstead UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ankur","family":"Khajuria","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Royal Free Hospital  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4588-8157","authenticated-orcid":false,"given":"R. Y.","family":"Kannan","sequence":"additional","affiliation":[{"name":"Facial Palsy Unit Queen Victoria Hospital  East Grinstead UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,8,17]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.4103\/0970-0358.155265"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199501000-00005"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1979.sp012733"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcms.2023.09.011"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcms.2018.02.014"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000001327"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000008302"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00266-007-9017-6"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0363-5023(88)90274-2"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0185(199710)249:2<276::AID-AR15>3.0.CO;2-L"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000002897"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1722905"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.31053"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40902-018-0163-3"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.31068"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/ca.23044"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31820e9138"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000637-198503000-00008"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2010.04.014"},{"issue":"4","key":"e_1_2_6_21_1","first-page":"340","article-title":"The need for routine assessment of masseter function after masseteric nerve harvest with the Borschel method","volume":"21","author":"Pescarini E.","year":"2019","journal-title":"JAMA Facial Plastic Surgery"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199209000-00009"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/0007-1226(87)90153-6"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.5540831115"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-197803000-00004"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1006501"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/0007-1226(84)90034-1"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1089\/fpsam.2020.0312"}],"container-title":["Clinical Anatomy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ca.24216","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T12:16:44Z","timestamp":1731586604000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ca.24216"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,17]]},"references-count":27,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1002\/ca.24216"],"URL":"https:\/\/doi.org\/10.1002\/ca.24216","archive":["Portico"],"relation":{},"ISSN":["0897-3806","1098-2353"],"issn-type":[{"value":"0897-3806","type":"print"},{"value":"1098-2353","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,17]]},"assertion":[{"value":"2024-04-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}