[Single-stage microsurgical reconstruction for facial palsy utilising the motor nerve to the masseter]

One of the most demanding areas in plastic surgery is reconstruction of the smile in the setting of facial palsy. A multitude of surgical techniques and approaches have been proposed with variable success rates. The most frequently applied treatment algorithm is a two-stage approach with placement of a cross-facial nerve graft (CFNG) initially and subsequent free functional muscle transfer. As this approach has several limitations, the authors have performed single-stage reconstructions utilising the motor nerve to the masseter as the donor nerve. Four patients underwent this single-stage reconstruction for facial palsy between July 2007 and May 2008. In all patients free functional transfer of the gracilis muscle was performed using the motor nerve to the masseter as the donor nerve. Outcome measures were functional result as well as patient satisfaction. The intraoperative as well as postoperative course was uneventful in all patients. In only one patient we encountered a small area of delayed wound healing which was amenable to conservative treatment. In all patients voluntary contraction of the gracilis muscle was visible after a mean period of 2.5 months. All patients displayed a high level of satisfaction with the functional result. Utilising the motor nerve to the masseter muscle as a donor nerve allows single-stage microsurgical reconstruction of the smile in the setting of facial palsy with reproducible results.