BACKGROUND: Nerve transfer is the main reconstructive option for facial reanimation in short-term facial paralysis when the main trunk of the facial nerve is damaged, but distal nerve branches remain functional and mimetic muscles are still viable1. The use of fibrin glue for peripheral nerve repair was relatively uncommon until the first commercially available fibrin sealant was introduced in the 1980s 2,3. In this article we describe the use of fibrin sealant for nerve coaptation without sutures in masseter-to-facial nerve transfer; and the results obtained utilizing this technique in a series of eleven patients.
METHODS: A retrospective review of the medical records of eleven patients with facial paralysis grades V-VI, who underwent masseter-to-facial nerve transfer for facial reanimation utilizing a fibrin sealant, without utilizing sutures for coaptation, was performed.
RESULTS: The follow up period ranged from 10 to 52 months. All patients recovered oral competence, eye closure, facial tone and a smile grade of 4,45 +/- 0,52 according to Terzis aesthetic and functional evaluation scale. Muscle contraction started 3–9 months postoperatively (average 4,7 +/- 2,3).
CONCLUSION: The use of fibrin glue without sutures for coaptation in masseter-to-facial nerve transfer, simplifies the procedure and shortens surgical timing, not requiring the material logistics of a microsurgical team, with similar results than coaptation performed with sutures. The masseter-to-facial nerve transfer is an effective technique for facial reanimation in short-term complete paralysis and mid-term partial paralysis.
1. Biglioli F, Frigerio A, Colombo V, et al. Masseteric-facial nerve anastomosis for early facial reanimation. J Craniomaxillofac Surg. 2012;40(2):149–155.
2. Egloff DV, Narakas A. Nerve anastomoses with human fibrin: Preliminary clinical report (56 cases). Ann Chir Main. 1983; 2:101–115.
3. Sameem M, Wood TJ, Bain JR. A systematicreviewon the use of fibrin glue for peripheral nerve repair. Plast Reconstr Surg. 2011;127(6):2381–2390.