End-to-Trunk Masseteric to Facial Nerve Transfer With Selective Neurectomy for Facial Reanimation

Abstract

Objective: To examine functional outcomes following end-totrunk masseteric to facial nerve transfer in patients with chronic flaccid facial paralysis. Design: Retrospective chart review. Setting: Tertiary-care private practice setting. Participants: Patients with complete unilateral facial paralysis of less than 24 months duration. Interventions: Direct end-to-trunk masseteric to facial nerve anastomosis.Outcome measures: Outcome measures included time to first movement, development of synkinesis, and an objective assessment of the resting tone and dynamic movement that was achieved. Results: Patient age at the time of transfer ranged from 6 to 61. Followup ranged from 12 to 24 months. No patients had any perioperative complications. No patient experienced significant mass movement or synkinetic facial movement with chewing. No patient had worsened chewing or swallowing. Patients have not yet recovered significant resting tone. All patients achieved smile activity when biting down with a median (interquartile range) oral commissure excursion of 7.57 mm (5.19-9.94 mm), starting 3 to 5 months after transfer. Conclusions: End-to-trunk masseteric to facial nerve transfer is a safe and effective procedure. Patients had rapid reinnervation with good excursion and achieved a natural appearing smile. The rehabilitated smile appears better than that achieved with hypoglossal-facial nerve transfer. The procedure can be performed coincident with cross-facial nerve grafting, and in some cases may produce dynamic facial movement that obviates the need for free muscle transfer.

Facial Paralysis Treatment Using Selective Neurectomy: A Comprehensive Review

“…Finally, as in the primary surgery, the wound is closed after drainage [ 13 ]. For complete unilateral facial paralysis, an effective and safe procedure called end-to-trunk masseteric to facial nerve transfer has been performed, resulting in a natural-looking smile [ 21 ]. Decompressing the facial nerve did not provide any advantages in cases of traumatic facial paralysis resulting from closed-head injuries [ 22 ].…”

Selective neurectomy for nonflaccid facial palsy

“…As selective neurectomy is often performed with other procedures, simultaneous surgeries (e.g. rhytidectomy, lid surgery and concurrent facial reanimation procedures) may confound direct outcome analysis [17 ▪ ,24,27]. Postoperative care also varies between institutions, leading to differences in chemodenervation and neuromuscular retraining in the perioperative period [16 ▪▪ ].…”

“…Vincent et al [24] also showed improvement in synkinesis and smile symmetry using efface. Leader et al [27] also combined masseteric-facial anastomosis with MSN, and reported dynamic movement with a more natural smile postoperatively. SAQ scores have been shown to decline following selective neurolysis [23].…”

Nerve guide conduits, nerve transfers, and local and free muscle transfer in facial nerve palsy

“…There is minimal donor site morbidity with masseter nerve transfer, and complication rates are generally low [41]. Synkinesis rate is lower than with hypoglossal nerve anastomosis [36,42,43]. In the study by Murphy et al [38], of 183 that underwent masseteric nerve transfer, 12 patients were reported to have complications, including four with masseter atrophy.…”