Facial Nerve Translocation for Low Tension Neurorrhaphy to Masseteric Nerve

Abstract

Introduction: The techniques of facial reanimation are continually evolving in search of the ideal method for rehabilitating the paralyzed face. In the past, alternative cranial nerve motor nuclei have been used to power facial musculature. The trigeminal nerve is gaining popularity as a promising nerve to drive facial motion, particularly in the lower face. Objectives: This article describes a low-tension technique of using the transposed facial nerve to the trigeminal nerve (masseteric branch) for facial reanimation. Methods: Six patients over 2.5 years were treated with facial nerve translocation with division at the geniculate and direct neurorrhaphy to the motor branch of the masseter. Patients were evaluated by physical examination, measurement of oral commissure excursion using MEEI FACE-gram software, video assessment, Sunnybrook Facial Grading System, Facial Disability Index, and Facial Clinimetric Evaluation Scale (FaCE). Results: Patients demonstrated early motion within 4 months postoperatively and were placed into facial physical therapy. All demonstrated improvements in oral competence, strong oral commissure excursion with good symmetry, speech improvements, and variable results in facial tone. Synkinesis to the smile antagonists in the lower face was noted and treated with chemodenervation in three of six. No upper division synkinesis was noted. Conclusion: The motor branch of the trigeminal nerve is an effective option for facial reanimation via facial nerve translocation and end-to-end neurorrhaphy. Variable results in facial tone were noted with excellent oral commissure excursion. This procedure is safe in the reoperated mastoid.

Dynamische Verfahren zur Gesichtsnervenrekonstruktion

“…Hier eignet sich eine Nerventransposition wie die Hypoglossus-Fazia-lis-Nervenanastomose. Zuletzt wurde gehäuft über die Transposition des N. massetericus, eines Astes des N. trigeminus, an den bukkalen Ast des N. facialis (NV-NVII-Jump) berichtet [17,18].…”

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

“…[10][11][12] Some authors have utilized both the masseteric and the hypoglossal nerve or translocated the facial nerve at the geniculate ganglion with drilling out the mastoid to improve resting facial tone. 13 We present our technique of direct end-to-end coaptation of the masseteric nerve to the facial nerve trunk with modified selective neurectomy (MFT-MSN) of distal branches to the depressor anguli oris (DAO) and platysma (Figure 1D). The goal is to increase the activity of zygomatic major/minor and innervate the levators, orbicularis oculi, orbicularis oris, and buccinator to improve overall facial symmetry and tone.…”

“…Overall, these techniques result in an excellent smile mechanism 10–12 . Some authors have utilized both the masseteric and the hypoglossal nerve or translocated the facial nerve at the geniculate ganglion with drilling out the mastoid to improve resting facial tone 13 …”

The Masseteric-Facial Anastomosis With Intratemporal Translocation of the Facial Nerve: Step-by-Step Technique and Results

“…The remaining step to be explored was the direct reinnervation of the entire facial nerve after intratemporal translocation. After the first publication 30 in 2018, followed by the paper by Hetzler, 31 we more extensively tested the effectiveness of this technique. The paper illustrates the tips and tricks and the results obtained in 11 patients.…”