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Gossett et al. Plast Aesthet Res 2021;8:60 https://dx.doi.org/10.20517/2347-9264.2021.69 Page 9 of 14

Figure 4. A 46-year-old male who underwent single-stage dual innervation gracilis free muscle transfer with cross-facial nerve graft
and masseteric nerve. The post-operative photo was taken 8 months after surgery.

Figure 5. A 46-year-old woman who underwent two-stage dual innervation gracilis free muscle transfer with cross-facial nerve graft
and masseteric nerve. The post-operative photo was taken 8 months after surgery.

second-year post-reanimation. This was faster than CFNG-innervated GFMT, which took 2 to 3 years to
achieve optimal results, and slower than the masseteric nerve group, which took 6 months to 1 year.
Interestingly, the CFNG-innervated GFMT cohort reported the highest patient satisfaction scores, followed
by SAN and then masseteric nerve . Nevertheless, because of potentially high donor site morbidity, the
[6]
SAN is seldom used as a source for innervation.

[49]
Conley and Baker popularized hypoglossal-facial coaptation. When the entire hypoglossal nerve is
sacrificed for facial reanimation, substantial donor site morbidity has been reported in the form of
hemilingual atrophy and deviation leading to dysarthria and dysphagia, and involuntary facial movement
[13]
and spasm with tongue movement . Given these issues, several techniques have been developed to
preserve the hypoglossal nerve function, such as partial nerve transfers and minimizing hypoglossal
[50]
manipulation with interposition cable grafts . Functionally, patients with GFMT innervated by the