Surgical correction of cheek biting in facial nerve paralysis using buccinator elevation

Cheek biting is an underrecognized sequela of facial nerve paralysis that is not captured by conventional grading systems. Although this symptom can cause persistent mucosal irritation and discomfort during mastication, surgical strategies specifically targeting cheek biting remain poorly defined.

A repeated-measures analysis was conducted within an IRB-approved prospective cohort at a single institution. Seven patients with facial nerve paralysis who reported symptomatic cheek biting underwent surgical treatment. Cheek biting was treated using a periosteal fixation technique designed to elevate the buccal musculature, and to displace the lax buccal mucosa away from the occlusal plane. Symptom severity was assessed using patient-reported scores before surgery and at 1 year postoperatively.

Seven patients were included (mean age 66.6 years; 4 males). The mean symptom score improved from 25.0 ± 18.9 preoperatively to 78.6 ± 20.8 postoperatively (p = 0.042). Intraoral photographs showed disappearance of buccal mucosal protrusion into the occlusal space after surgery. Postoperative photographs demonstrated elevation of the cheek soft tissue with a mild smiling appearance.

Buccinator elevation for cheek biting in patients with facial nerve paralysis was minimally invasive, technically straightforward, and associated with symptomatic improvement. This technique may represent a useful surgical option for selected patients with symptomatic cheek biting related to facial nerve paralysis.