In the case of aged patients with chronic facial palsy with severe muscular atrophy, muscle transposition is a good alternative in order to supply some form of movement. The masseter muscle may be transposed through either an intra-or extraoral approach. In the extraoral technique, most of the surgical details have been well documented, except the relationships between the masseter muscle and the parotid duct. Considering the anatomic direction of the parotid duct, a perfect axis of traction is available in order to lift both lips and the buccal commissure. Ten cases of extraoral masseter muscle transposition above the parotid duct were analyzed. Complete facial paralysis resulted from tumor extirpation (seven cases), arteriovenous malformation (two cases) or trauma (one case). The patients' ages ranged from 47 to 76 years with a median age of 60 years; seven patients were female and three male. The duration of the palsy prior to the muscle transposition, ranged from 8 months to 18 years. The overall results were satisfactory in nine cases. Extraoral masseter muscle transposition is particularly attractive as a primary procedure, because of its efficiency in elderly patients with long-standing facial palsy. As a secondary procedure, masseter transposition may be considered as good an alternative for rehabilitation, when other reconstructive techniques have failed.

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