Neoplastic, Inflammatory and Degenerative Conditions

Facial Paralysis

Masseteric-facial nerve coaptation – an alternative technique for facial nerve reinnervation

Coombs CJ, Ek EW, Wu T, et al (Royal Children’s Hosp, Parkville, Melbourne, Victoria, Australia; et al) J Plast Reconstr Aesthet Surg 62:1580-1588, 2009^§

S.H. Miller, MD, MPH

Evidence Ranking

• C

Expert Rating

• 2

Abstract

Background

Reinnervation of the facial musculature when there is loss of the proximal facial nerve poses a difficult clinical problem. Restoration of spontaneous mimetic motion is the aim and, to this end, the use of cross-facial nerve grafts has long been considered the reconstruction of choice. The nerve to masseter has been used very successfully for reinnervation of microvascular functioning muscle transfers for facial reanimation in established facial palsy but its use as a direct nerve transfer to the facial nerve to reinnervate ‘viable’ facial musculature has been scarce.

Methods

Electron micrographic studies of axonal counts in the nerve to masseter and nerve to gracilis in a clinical series of seven patients undergoing surgery for facial nerve palsy were made. Based on these results, and previous success with the use of the nerve to masseter for reinnervation of free gracilis transfers, we report our experience with the transfer of the nerve to masseter for direct coaptation with the ipsilateral facial nerve to restore facial motion.