A Comparison of Commissure Excursion following Gracilis Muscle Transplantation for Facial Paralysis Using a Cross-Face Nerve Graft versus the Motor Nerve to the Masseter Nerve

Abstract

These results indicate that segmental gracilis muscle transplantation using the motor nerve to the masseter nerve for facial animation in children is a very reproducible operation and provides a commissure excursion in the range of normal.

Salvage Procedures After Failed Facial Reanimation Surgery Using the Masseteric Nerve as the Motor Nerve for Free Functional Gracilis Muscle Transfer

“…However, the success depends not only on whether the free tissue transfer survives but also on whether coaptation to the CFNG and the consecutive muscle reinervation are sufficient to generate a smile that is symmetrical to the healthy nonparalyzed side. In our hands and according to the literature, 4 the CFNG delivers less neural input than the masseteric nerve as a donor nerve, resulting in less muscle excursion. This procedure can lead to unsatisfactory results because of insufficient muscle excursion, especially in patients who have high excursion of the oral commissure on the healthy side when smiling.…”

Facial animation in patients with Moebius and Moebius-like syndromes

“…Sufficient innervation must be present to power the muscle, and this innervation must be specific to the desired activity to achieve spontaneity, synchronicity and symmetry. The contralateral seventh nerve, by means of a cross-facial nerve graft, provides the preferred innervation for a muscle transfer in unilateral facial paralysis reconstruction 2,8,10,12,18,22,23 . When the VII nerve is not adequate in a person who has a very powerful smile on their normal side or in patients with bilateral forms, the authors used the motor nerve to the masseter muscle.…”

Facial Nerve Innervation and Facial Palsies

“…An experimental rabbit model has con fi rmed that the axonal morphometry and tetanic force produced by transferred muscles are comparable in one-and two-stage procedures (UrsoBaiarda and Grobbelaar 2009 ) . Bae et al described free gracilis transfer with direct coaptation to the ipsilateral masseteric branch of the trigeminal nerve which provided good excursion of the oral commissure but lacked the synchronous movement achieved with a CFNG (Bae et al 2006 ) . This option may be of bene fi t in older patients or in recovery operations where a previous standard approach has failed.…”