Masseter-to-Facial Nerve Transfer in Facial Palsy

Introduction: Facial reanimation with primary nerve grafting requires a long reinnervation time with the likelihood of significant synkinesis and variable outcomes. The masseter branch of cranial nerve V has been described as a donor source for fast neurotization of the facial nerve.

This presentation describes the authors’ experience with facial reanimation using the masseter-to-facial nerve transfer.

Methodology and Material: A retrospective study was performed on four consecutive facial paralysis patients treated in 2013 with a masseter-to-facial nerve transfer for reanimation of the midface and perioral region.

Postoperatively, botulinum toxin was injected in the contralateral hemiface to reduce muscular hyperkinesis.

Outcomes evaluated included, through physical examination and video analysis: time to reinnervation, commissure excursion, speech, oral competence and mastication.

Results: All patients had evidence of dynamic facial reanimation at 4-6 months postoperatively, with oral competence, good resting tone, and a smile with a vector and strength comparable to those of the normal side.

There were no surgical complications.

At the present date, patients were still not able to smile independently of jaw closure.

Conclusions: Masseter-to-facial nerve transfer provides rapid and reliable dynamic facial reanimation with the advantages of a limited donor-site morbidity and avoidance of interposition nerve grafts.

However, this study failed to demonstrate a spontaneous movement independent of jaw closure - although it has been described in the literature with this technique - probably due to the short follow-up period