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Related Experiment Video

Updated: Sep 19, 2025

Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer
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Masseter nerve transfer with dual function for smile and eye closure.

Katie Hicks1, Christine B Novak1, Moaath Saggaf1

  • 1Division of Plastic, Reconstructive & Aesthetic Surgery, Department of Surgery, University of Toronto, Faculty of Medicine, Canada.

Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS
|June 3, 2025
PubMed
Summary

Selective masseter nerve (MN) transfer effectively restores orbicularis oculi (OO) muscle function for eye closure in facial nerve palsy patients. This technique offers a viable option for facial reanimation, crucial for corneal protection.

Keywords:
Eye closureFacial palsyFacial paralysisMasseter nerveNerve transfer

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Area of Science:

  • Neurosurgery
  • Facial Plastic Surgery
  • Reconstructive Surgery

Background:

  • Facial nerve palsy impairs eye closure and facial symmetry.
  • Masseter nerve (MN) transfer is a potential surgical option for reanimating the orbicularis oculi (OO) muscle.
  • Comparing selective MN transfer to cross-face nerve grafting (CFNG) is important for optimizing outcomes.

Purpose of the Study:

  • To evaluate the effectiveness of selective MN transfer in reinnervating the OO muscle for improved eye closure in facial nerve palsy.
  • To compare functional outcomes of selective MN transfer versus CFNG for OO reinnervation.

Main Methods:

  • Retrospective study of 16 adult patients with facial nerve palsy undergoing selective MN transfer and CFNG for dual reinnervation of OO and zygomaticus major.
  • Outcomes assessed via electromyography, clinical evaluation, Sunnybrook Facial Grading System, and eMotrics for eye closure.
  • Follow-up included clinical assessment (mean 29.4 months) and video analysis (mean 20.6 months).

Main Results:

  • Significant improvements observed in cheek resting symmetry, voluntary gentle eye closure, and smile symmetry postoperatively.
  • All patients demonstrated OO reinnervation via MN transfer on electromyography.
  • Postoperative eyelid position showed significant differences with MN transfer activation.

Conclusions:

  • Selective MN transfer is effective in achieving functional reinnervation of the OO muscle, facilitating eye closure.
  • The procedure leads to significant improvements in facial symmetry and dynamic function.
  • Selective MN transfer should be considered for facial reanimation, particularly for corneal protection.