Purpose of review: To review the growing literature on the use of the masseteric nerve in facial reanimation, from direct neurotization, to ‘baby-sitter’ techniques, to its use in powering neuromuscular free tissue transfer. We focus on the indications for the different uses based on the timing of the facial paralysis and other patient factors.
Recent findings: The use of the masseteric nerve in facial reanimation is gaining widespread acceptance for use in an expanding number of clinical scenarios. Surgeon's experience and preference as well as patient selection are very important factors in choosing the appropriate surgical use of this nerve.
Summary: Facial reanimation surgery is a difficult challenge for any reconstructive surgeon. The use of the masseteric nerve branch to reanimate the face is gaining popularity. Its versatility, anatomical location, relative ease of dissection, low morbidity, and high potential for motor neural input make it an excellent option for many different reanimating techniques. The appropriate nerve use should be based on the type of facial paralysis, its timing, and patient factors such as age, prognosis, and desires. Understanding the benefits and potential drawbacks of utilizing this nerve represents an essential piece of knowledge for the facial reanimation surgeon.