{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T19:33:23Z","timestamp":1774726403511,"version":"3.50.1"},"reference-count":27,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>An unanswered question in facial reanimation surgery is how to improve the results of conventional primary cross\u2010facial nerve grafts. In this study, we designed a study to determine whether vascularizing cross\u2010facial nerve grafts with shorter lengths following intra\u2010oral insets, provides sufficient neural input to the targeted smile\u2010mimetic muscles without the need for a concomitant \u201cbabysitter\u201d procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>In a retrospective review of practice over 5\u2009years on facial palsy patients with smile asymmetry, we performed a combination of the intra\u2010oral vascularized nerve graft (VNG) which connects the buccal branches of the facial nerve, that supply the smile\u2010mimetic muscles, on either side of the face; the \u201cKoshima\u2010type\u201d procedure. This VNG is performed in combination with a forked fascicular transfer of the masseteric nerve, which is coapted to the zygomatic branches of the facial nerve (Group I). In Group II, only the \u201cKoshima\u2010type\u201d procedure was performed without a \u201cbabysitter\u201d procedure, which only connected the buccal branches of the facial nerve on either side (Group II). Both approaches were statistically compared in cases of acute facial palsy (within 24 months of onset), in those with no pre\u2010existing synkinesis. Statistical analysis was performed using the Mann\u2013Whitney test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of a total of 13 patients in the overall cohort; seven in Group I and six in Group II, there was a significant improvement in both groups in terms of an open mouth smile following surgery (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), with no statistically significant difference between them (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009ns); but in terms of snarl movement, only patients in Group II showed significant improvement in upper lip elevation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The \u201cKoshima\u2010type\u201d procedure alone is sufficient in providing optimal and spontaneous smile reanimation, without the need for a \u201cbabysitter\u201d procedure, provided it is performed within 24 months in facial palsy patients with no clinical or neurophysiological evidence of reinnervation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/micr.70151","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T05:34:52Z","timestamp":1764048892000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Intra\u2010Oral Vascularized Cross\u2010Facial Nerve Grafts in Early Flaccid Facial Palsy: A Five\u2010Year Review of Clinical Practice"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4588-8157","authenticated-orcid":false,"given":"R. Y.","family":"Kannan","sequence":"first","affiliation":[{"name":"Facial Palsy Unit Queen Victoria Hospital  East Grinstead UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Neville","sequence":"additional","affiliation":[{"name":"Facial Palsy Unit Queen Victoria Hospital  East Grinstead UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Gwynn","sequence":"additional","affiliation":[{"name":"Facial Palsy Unit Queen Victoria Hospital  East Grinstead UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4060-4936","authenticated-orcid":false,"given":"K.","family":"Young","sequence":"additional","affiliation":[{"name":"Facial Palsy Unit Queen Victoria Hospital  East Grinstead UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Selley\u2010West","sequence":"additional","affiliation":[{"name":"Facial Palsy Unit Queen Victoria Hospital  East Grinstead UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Facial Palsy Unit Queen Victoria Hospital  East Grinstead UK"},{"name":"Department of Oculoplastic Surgery Queen Victoria Hospital  East Grinstead UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Nduka","sequence":"additional","affiliation":[{"name":"Facial Palsy Unit Queen Victoria Hospital  East Grinstead UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,24]]},"reference":[{"issue":"6","key":"e_1_2_11_2_1","first-page":"727","article-title":"Long\u2010Term Outcome in 38 Consecutive Permanent Recent Facial Palsy Patients After Triple Innervation Technique","volume":"53","author":"Allevi F.","year":"2025","journal-title":"Journal of Craniofacial Surgery"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2012.04.030"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000005871"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.2220\/biomedres.43.145"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.31053"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40902-018-0163-3"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2019.11.004"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamafacial.2019.0035"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/ca.23332"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.31068"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000637-198503000-00008"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2010.04.014"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000009775"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/ca.10016"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nmd.2025.105393"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/0007-1226(80)90013-2"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/0014-4886(60)90037-6"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0363-5023(87)80129-6"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/ca.24216"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0194-59989670206-1"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2014.01.009"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.5540831115"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-197803000-00004"},{"issue":"3","key":"e_1_2_11_25_1","first-page":"264","article-title":"Vascularized Nerve Grafts. A Review","volume":"14","author":"Terzis J. K.","year":"1995","journal-title":"International Angiology"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31819ba4bb"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181babb93"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2024.1440953"}],"container-title":["Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.70151","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/micr.70151","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.70151","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T09:06:47Z","timestamp":1773133607000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/micr.70151"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,24]]},"references-count":27,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1002\/micr.70151"],"URL":"https:\/\/doi.org\/10.1002\/micr.70151","archive":["Portico"],"relation":{},"ISSN":["0738-1085","1098-2752"],"issn-type":[{"value":"0738-1085","type":"print"},{"value":"1098-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,24]]},"assertion":[{"value":"2025-08-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70151"}}