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Facial Reanimation Using the Masseter-to-Facial Nerve Transfer

Klebuc, Michael J. A. M.D.

Plastic and Reconstructive Surgery: May 2011 - Volume 127 - Issue 5 - p 1909-1915
doi: 10.1097/PRS.0b013e31820e9138
Reconstructive: Head and Neck: Original Articles

Background: This article describes facial reanimation using the transfer of the trigeminal motor nerve branch of the masseter muscle (masseter nerve) to the facial nerve (masseter-to-facial nerve transfer).

Methods: A retrospective review was performed of 10 consecutive facial paralysis patients treated with a masseter-to-facial nerve transfer for reanimation of the midface and perioral region over a 7-year period. Patients were evaluated with physical examination, direct measurement of commissure excursion, and video analysis.

Results: All patients regained oral competence, good resting tone, and a smile, with a vector and strength comparable to those of the normal side. Motion developed an average of 5.6 months after masseter-to-facial nerve transfer, with 40 percent of patients developing an effortless smile by postoperative month 19.

Conclusions: The masseter-to-facial nerve transfer is an effective method for reanimation of the midface and perioral region in a select group of facial paralysis patients. The technique is advocated for its limited donor-site morbidity, avoidance of interposition nerve grafts, and potential for cerebral adaptation, producing a strong, potentially effortless smile.

Houston, Texas

From the Center for Facial Paralysis Surgery and Functional Restoration, Institute for Reconstructive Surgery, The Methodist Hospital.

Received for publication May 29, 2010; accepted October 6, 2010.

Presented at the Third Congress of the World Society for Reconstructive Microsurgery, in Buenos Aires, Argentina, October 23 through 26, 2005, and at the 21st Annual Meeting of the American Society for Reconstructive Microsurgery, in Fajardo, Puerto Rico, January 15 through 18, 2005.

Disclosure:The author has no financial interest to declare in relation to the content of this article.

Michael J. A. Klebuc, M.D., Institute for Reconstructive Surgery, The Methodist Hospital, 6560 Fannin, Suite 2200, Houston, Texas 77030,

©2011American Society of Plastic Surgeons