Facial Reanimation with Masseteric-Facial Nerve Anastomosis Following Skull Base Surgery

Background: Hypoglossal-facial nerve anastomosis has been widely used for facial reanimation. However, hemiglossal dysfunction remains a possible disadvantage of this procedure. Use of the masseteric nerve has recently been shown to be useful as a primary modality for facial reanimation. We present our experience with masseteric-facial nerve anastomosis for patients with irreversible facial palsy after skull base surgery.

Methods: In the period from 2009 to 2011, five patients with irreversible facial palsy after extirpation of skull base tumors were treated with masseteric-facial nerve anastomosis. The age of the patients ranged from 53 to 61 years (mean, 57 years), and all were female. The duration of paralysis was no longer than 11 months. Follow-up periods were from 8 to 31 months (mean, 20 months). The upper division of the facial nerve was generally selected for masseteric-facial nerve anastomosis. In four cases, the procedure was performed in conjunction with a cross-face nerve graft between the contralateral and affected zygomatic branch.

Results: Four patients regained facial movements within 5 months postoperatively. They were able to produce a voluntary smile. One case, who had been treated with a steroid for pneumonia, failed to show reanimation. Masseter muscle contraction was preserved in every patient.

Conclusions: Masseteric-facial nerve anastomosis is an alternative method for reanimation of the midface. The major advantage over the other cranial nerve donors is the lack of functional impairment of mastication. Moreover, the masseteric nerve has a sufficient nerve length without the need for interpositional nerve grafting for masseteric-facial anastomosis, and this accelerates facial muscle reinnervation.