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Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer

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End-to-Trunk Masseteric to Facial Nerve Transfer With Selective Neurectomy for Facial Reanimation.

Brittany Leader¹, Garrett R Griffin², Babak Larian²

¹University of Cincinnati Medical Center, Cincinnati, OH.

The Journal of Craniofacial Surgery

|November 2, 2021

Summary

End-to-trunk masseteric to facial nerve transfer offers a safe and effective solution for chronic facial paralysis. Patients achieve rapid reinnervation and a natural smile with good oral commissure excursion.

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Area of Science:

Neurosurgery
Plastic Surgery
Facial Reanimation Surgery

Background:

Chronic flaccid facial paralysis significantly impacts quality of life.
Nerve transfer procedures aim to restore facial muscle function.
Masseteric to facial nerve transfer is a viable option for facial reanimation.

Purpose of the Study:

To evaluate functional outcomes of end-to-trunk masseteric to facial nerve transfer.
To assess the safety and efficacy of this nerve transfer technique.
To compare outcomes with other facial reanimation methods.

Main Methods:

Retrospective chart review of patients with chronic unilateral facial paralysis.
Direct end-to-trunk masseteric to facial nerve anastomosis performed.
Outcome measures included time to movement, synkinesis, resting tone, and dynamic movement.

Main Results:

No perioperative complications were reported.
Patients achieved smile activity with a median oral commissure excursion of 7.57 mm within 3-5 months.
No significant mass movement, synkinesis with chewing, or chewing/swallowing dysfunction observed.

Conclusions:

End-to-trunk masseteric to facial nerve transfer is safe and effective for facial paralysis.
Rapid reinnervation and natural smile with good excursion were achieved.
This technique may offer superior results compared to hypoglossal-facial nerve transfer and can obviate free muscle transfer.