Retrospective study of the functional recovery of men compared with that of women with long-term facial paralysis

Sex is likely to play an important part in reanimation of the face after paralysis, with women being superior in terms of resistance to neural injury and regeneration. Our aim was to evaluate the influence of the sex of the patient on the recovery of facial paralysis after surgical reanimation by comparing the degree of restored movement between men and women with long-standing paralysis that was reanimated by transfer of the hypoglossal nerve or cross-face nerve grafting. Between 1999 and 2010 we operated on 174 patients with facial paralysis. Of these we studied 26 cases (19 women and 7 men) with complete long-standing paralysis reanimated with either cross-face nerve grafting (n = 14) or transfer of the hemihypoglossal nerve (n = 12). The degree of movement restored was recorded in each case. Statistical analysis showed that in cases with long-standing paralysis women had significantly more movement restored than men for both cross-face nerve grafting (p = 0.02) and hypoglossal transposition (p = 0.04). We conclude that, after a neural injury, women tend to maintain the viability of the facial musculature longer than men, which suggests that they are more resistant to both denervation and the development of muscular atrophy. Whether this phenomenon can be explained by neural or muscular processes, or both, warrants further studies.