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Five-Year Experience with Fifth-to-Seventh Nerve Transfer for Smile

Banks, Caroline A. M.D.; Jowett, Nate M.D.; Iacolucci, Carlo M.D.; Heiser, Alyssa B.A.; Hadlock, Tessa A. M.D.

Plastic and Reconstructive Surgery: May 2019 - Volume 143 - Issue 5 - p 1060e-1071e
doi: 10.1097/PRS.0000000000005591
Reconstructive: Head and Neck: Original Articles

Background: Masseteric- or deep temporal–to-facial nerve transfer (five-to-seven nerve transfer) is increasingly used in facial reanimation; however, the indications and clinical variables affecting outcomes for five-to-seven nerve transfer have not been defined. The authors describe their early experience with five-to-seven nerve transfer, reporting function and patient-reported outcomes, to identify potential parameters that are predictive of outcome.

Methods: The authors conducted a retrospective chart review of all patients who underwent five-to-seven nerve transfer for smile reanimation from 2012 to 2017. Age, sex, cause of facial paralysis, onset and duration of paralysis, history of adjuvant chemotherapy and/or radiation therapy, donor nerve used, adjunctive procedures, and final excursion were recorded. Standard photographs and videos, and data regarding clinical facial nerve function and patient-reported quality of life, were obtained preoperatively and postoperatively.

Results: Sixty patients were identified. Forty-seven had flaccid facial paralysis and 13 had postparalysis facial palsy. Among flaccid facial paralysis patients, masseteric nerve transfer was successful in 30 patients (88 percent) and deep temporal nerve transfer was successful in three cases (60 percent). Among postparalysis facial palsy patients, five-to-seven nerve transfer was successful in two patients (20 percent). Average quality-of-life scores improved significantly from preoperatively (46) to postoperatively (59) among flaccid facial paralysis patients with successful five-to-seven nerve transfer.

Conclusions: Five-to-seven nerve transfer is a viable option in facial reanimation. Shorter denervation times and preoperative flaccidity are favorable predictors of outcome. Five-to-seven nerve transfer as an adjunct to primary repair appears highly effective for enhancing smile function. Five-to-seven nerve transfer results are not reliable in patients with postparalysis facial palsy.


Boston, Mass.

From the Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear Infirmary.

Received for publication July 31, 2017; accepted September 27, 2018.

Presented at the 13th International Facial Nerve Symposium, in Los Angeles, California, August 3 through 6, 2017.

Disclosures:The authors have no financial interest to declare in relation to the content of this article.

Caroline A. Banks, M.D., 243 Charles Street, Boston, Mass. 02114,

Copyright © 2019 by the American Society of Plastic Surgeons