Copyright © 2015 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited. www.PRSJournal.com 267 O ccasionally, patients present to the clinic with facial palsy after intracranial resection and grafting of the facial nerve in the setting of skull base tumors. The degree of palsy varies, but invariably these patients inquire as to the progres- sion, fnal facial function, and the need for and tim- ing of future operations. The primary study goals Disclosure: The authors have no financial interest to declare in relation to the content of this article. Copyright © 2015 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0000000000001881 Shai M. Rozen, M.D. Bridget L. Harrison, M.D. Brandon Isaacson, M.D. J. Walter Kutz, Jr., M.D. Peter S. Roland, M.D. Patricia A. Blau, Ph.D. Samuel L. Barnett, M.D. Bruce E. Mickey, M.D. Dallas, Texas Background: Reconstructive surgeons may encounter patients presenting after intracranial facial nerve resection and grafting in the setting of skull base tumors, who inquire regarding progression, fnal facial function, and need for future operations. Study goals were to analyze global and regional facial function using established grading systems and videography, while examine variables possibly affecting outcomes. Methods: Between 1997 and 2012, 28 patients underwent intracranial nerve grafting. Fifteen were prospectively evaluated by three facial nerve physical therapists with the Facial Nerve Grading System 2.0 and the Sunnybrook Facial Grading Score for function and the Facial Disability Index for quality of life. Still photographs and videography were used to assess quality of motion and tone, while demographic and medical variables were analyzed regarding their effect on end results. Results: Average patient age was 41.9 years (range, 22 to 66 years), and there were 10 women and fve men. Average time interval between nerve grafting and evaluations was 42.9 months (range, 12 to 146 months). Both grading scores demonstrated best outcomes in the periorbita and worst outcomes in the brow. Buccinator muscle tone also improved. The average total Facial Dis- ability Index was 67.5 percent. Although not statistically signifcant, the data suggest that nerve gap length affected total resting symmetry and voluntary movement, whereas preoperative palsy and age may affect total resting symme- try. Perioperative radiation therapy, tumor type, donor nerve, and coaptation technique were not found to affect outcomes. Conclusions: Intracranial facial nerve grafting largely provides better resting tone and facial symmetry, potentially improving end results of future intervention; how- ever, overall voluntary facial motion is poor. (Plast. Reconstr. Surg. 137: 267, 2016.) CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. From the Departments of Plastic Surgery, Otolaryngology, Physical Therapy, and Neurosurgery, University of Texas Southwestern. Received for publication May 27, 2015; accepted August 24, 2015. Presented at the Best Paper Session at the American Society of Reconstructive Microsurgery Meeting, in Paradise Island, Bahamas, January 21 through 27, 2015; and at the 94th Annual Meeting of the American Association of Plastic Surgeons, in Scottsdale, Arizona, April 11 through 14, 2015. Intracranial Facial Nerve Grafting in the Setting of Skull Base Tumors: Global and Regional Facial Function Analysis and Possible Implications for Facial Reanimation Surgery Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web brows- er to access this content. Clickable links to the ma- terial are provided in the HTML text of this article on the Journal ’s Web site (www.PRSJournal.com). RECONSTRUCTIVE