Bilateral reconstruction of smile through muscular transplants neurotized to masseter nerves

In recent years, microsurgical transplant of the gracilis muscle has been the most widely used technique in the dynamic rehabilitation of the smile. The most frequently used donor nerve is the seventh cranial nerve, as it allows for the most physiological rehabilitation, including the rehabilitation of spontaneous smile. An exception to this is the case of bilateral facial paralyses, in which there is no contralateral nerve to be used as a donor. In these cases, it is necessary to use other nerves such as the hypoglossal, the accessory nerve, or the masseter branch of the trigeminal nerve. In this article, we describe a case of dynamic bilateral facial rehabilitation with a bilateral transplant of the gracilis muscle neurotized to the masseter nerve to achieve a strong, symmetrical smile, which is properly controlled by the patient.