To exemplify the importance of standardizing the use of electromyography (EMG) prior to and following face transplantation (FT) to determine surgical candidacy and prognosticate neurological outcomes.

Clinical records of two FT recipients were reviewed and an extensive review of the literature for EMG use in FT was performed.

Two patients underwent FT with pre/post-transplant EMG recordings. 

Patient 1: Forty-one year-old male with extensive facial burn injuries. Pre-transplant EMG showed normal facial nerve function. Neurological examination one month post-transplant demonstrated difficulty in lip puckering and mildly dysarthric speech with bilateral loss of sensation in the V3 distribution of the trigeminal nerve, otherwise non-focal. Post-transplant EMG one-month post-transplant was consistent with denervation and reinnervation with nil voluntary units in the left orbicularis oculi.

Patient 2: Twenty-five year-old male with extensive facial disfigurement secondary to ballistic injury. Pre-transplant EMG showed axonal damage to the facial nerve bilaterally. Neurological examination one month post-transplant showed wrinkling of the forehead and closure of the eyes (left stronger than right). Facial motor activity was otherwise absent. Post-transplant EMG showed difficulty in obtaining compound muscle action potentials of the right nasalis/orbicularis oris. The right orbicularis oris showed membrane instability.

Pre-transplant EMGs in two FT recipients correlated with their neurological outcomes at one-month post-transplant. Combining neurological exams with facial nerve EMGs increases sensitivity to motor activity detection and signs of reinnervation. Standardized baseline facial nerve EMGs prior to FT can help determine surgical candidacy. These baseline results can help determine optimal intervals for post-transplant EMGs. Predicting post-transplant facial reinnervation is critical for prognosticating neurological outcomes and guiding patient expectations.