Masseter–to-Facial Nerve Transfer: A New Technique for Facial Reanimation

Adjacent cranial nerve transfers provide an effective strategy for reanimating the paralyzed face in the presence of distal facial nerve branches and viable mimetic muscles. Traditionally, complete XII-to-VII crossovers have been utilized with significant rates of tongue atrophy, speech impairment, and swallowing difficulties.

The motor nerve branch to the masseter muscle (CN V) represents an alternate donor nerve to transfer (V-to-VII) or power free muscle flaps. The V-to-VII transfer has several advantages over traditional options: 1) Limited donor site morbidity - no significant impairment of mastication as function is duplicated by the temporalis muscle. 2) Incomplete denervation - selective use of the distal motor nerve branch prevents masseter muscle atrophy and development of a contour abnormality. 3) Anatomic location - proximity to the facial nerve permits tension- free nerve repair without nerve grafts. 4) Rapid recovery - return of tone and facial motion an average of 6 months after surgery. 5) Efficient cerebral adaptation and production of an effortless smile.

In this presentation, the author outlined initial experience with the masseter–to–facial nerve transfer. The local anatomy and surgical technique were illustrated. Pre- and postoperative video were provided for outcomes evaluation.