ost tumors of the parotid gland are benign and can be adequately treated with facial nerve-sparing parotidectomy. Malignant tumors constitute approximately 20% of all tumors of the parotid gland, and about 20% of these will have facial nerve involvement. 1,2 Total parotidectomy with resection of the involved portion of the facial nerve is recommended when the tumor infiltrates or is adherent to the facial nerve. Immediate reconstruction of the resected nerve should be performed when feasible to mitigate the devastating effects of facial paralysis. 3 Facial paralysis has functional and aesthetic effects, including an asymmetric smile, oral incompetence, nasal obstruction, and lagophthalmos with a potential for corneal injury. These physical effects can have a significant psychosocial impact and result in a decline in the patient's quality of life. 4 Three options exist for nerve reconstruction, which depend on the extent of the nerve resection. Primary tension-free coaptation of the nerve segments is the best option when feasible. Cable grafting between the proximal and distal nerve stump is performed when the length of the resected nerve segment prevents primary coaptation, and a mastoid dissection may be indicated to gain access to the proximal stump of the facial nerve in some cases. 5 Nerve substitution is indicated when the proximal segment of the facial nerve is not accessible. Donor nerve graft options frequently used in facial nerve reconstruction include the great auricular nerve, sural nerve, and medial antebrachial cutaneous nerve. The medial antebrachial cutaneous nerve can be harvested with multiple branches that make it suitable for reconstruction of multiple peripheral branches. Compared with primary nerve repair, cable grafting has a slower return of nerve function and an increased rate of synkinesis. 5-7 Synkinesis results from aberrant axonal regeneration, which causes simultaneous movement of multiple muscle groups when 1 group is activated. Using a separate neural input for innervation of the upper and lower facial muscle groups can prevent or decrease synkinesis. A 2011 report by IMPORTANCE Reconstruction of the facial nerve after radical parotidectomy is commonly performed with cable grafting, which is associated with slow recovery of nerve function and synkinesis. OBJECTIVE To describe facial nerve reconstruction after radical parotidectomy using concurrent masseteric nerve transfer and cable grafting. DESIGN, SETTING, AND PARTICIPANTS This retrospective medical record review at a tertiary referral hospital included 9 patients who underwent concurrent masseteric nerve transfer and cable grafting for facial nerve reconstruction performed by a single surgeon from January 1, 2014, to October 31, 2015. Final follow-up was completed on March 14, 2016. MAIN OUTCOMES AND MEASURES Improvement in resting facial symmetry and oral commissure excursion and synkinesis. RESULTS Nine patients (6 women; mean age, 62.6 years; age range, 51-73 years) underwent immediate facial nerve reconstruction after radic...