Masseter nerve-based facial palsy reconstruction

Abstract

Facial paralysis is a devastating disease, the treatment of which is challenging. The use of the masseteric nerve in facial reanimation has become increasingly popular and has been applied to an expanded range of clinical scenarios. However, appropriate selection of the motor nerve and reanimation method is vital for successful facial reanimation. In this literature review on facial reanimation and the masseter nerve, we summarize and compare various reanimation methods using the masseter nerve. The masseter nerve can be used for direct coaptation with the paralyzed facial nerve for temporary motor input during cross-facial nerve graft regeneration and for double innervation with the contralateral facial nerve. The masseter nerve is favorable because of its proximity to the facial nerve, limited donor site morbidity, and rapid functional recovery. Masseter nerve transfer usually leads to improved symmetry and oral commissure excursion due to robust motor input. However, the lack of a spontaneous, effortless smile is a significant concern with the use of the masseter nerve. A thorough understanding of the advantages and disadvantages of the use of the masseter nerve, along with careful patient selection, can expand its use in clinical scenarios and improve the outcomes of facial reanimation surgery.

Post-surgery Rehabilitative Intervention Based on Imitation Therapy and Mouth-Hand Motor Synergies Provides Better Outcomes in Smile Production in Children and Adults With Long Term Facial Paralysis

“…The inclusion criteria were: (1) unilateral or bilateral congenital facial paralysis (Moebius syndrome); (2) unilateral established long term facial palsy (>18 months) ( 31 ); (3) facial animation via gracilis neuromuscular transplantation and re-innervation with ipsilateral masseteric nerve; (4) Post SS rehabilitation with traditional treatment (control group, CG). (5) Post SS rehabilitation with FIT-SAT (experimental group, EG); (6) absence of congenital hands malformations; (7) absence of any psychiatric or physical illness at the time of participation; (8) age >6 years.…”

Facial reanimation using the hypoglossal nerve and ansa cervicalis: a short-term retrospective analysis of surgical outcomes

“…Numerous strategies are used to manage facial palsy. Various surgical treatments have been utilized as dynamic procedures for facial paralysis [ 1 ], including cross-face nerve grafting; transfers of the hypoglossal nerve, masseter nerve [ 2 ], and ansa cervicalis [ 3 ]; temporalis muscle transfer [ 4 ]; and functional muscle transpositions. In 1903, Korte [ 5 ] introduced hypoglossal nerve transfer with end-to-end coaptation, which has been considered as the traditional method.…”

Early Simultaneous Cross Facial Nerve Graft and Masseteric Nerve Transfer for Facial Paralysis after Tumor Resection

“…8,26 However, the prolonged axonal generation (4-6 months) required by cross facial nerve grafts led to the inception of dual motor reanimation procedures combining nerve transfers with cross facial nerve grafts. 11 A "babysitter" procedure was first described by Terzis et al in 1984 using the hypoglossal nerve, 9 and the principle was more recently adapted using the masseteric nerve as the babysitter, with favorable reported outcomes in patients following tumor extirpation. 10 Denervation time is a key consideration in outcomes of neurotization procedures for facial paralysis patients.…”