PR08
NERVE TO MASSETER – THE KEY TO RELIABLE RESULTS IN FACIAL REANIMATION

Abstract

Purpose:   Free muscle microvascular transfer has been the preferred procedure for reanimation of the face in young patients with facial palsy. Historically, the use of the contralateral facial nerve via a cross facial nerve graft has been the chosen method for innervation. However, this usually involves a two‐stage procedure, precludes treatment of patients with bilateral facial paralysis and has had variable results with symmetry, tone and strength of voluntary movements. The unreliability of result has been greater in older patients. The nerve to masseter has been successfully shown to provide a reliable alternative for use in facial reanimation with both free muscle transfer and direct nerve transfer to the facial nerve. We present the results of cases using the nerve to masseter in both middle‐aged adult and paediatric free gracilis transfer and also with direct innervation with the facial nerve in the elderly.Methodology:   Nine patients with facial nerve paralysis underwent reanimation surgery utilising the nerve to masseter. Three adult and three paediatric patients received free gracilis muscle transfer. Three other elderly patients underwent transfer of the ipsilateral masseteric nerve to facial nerve through direct coaptation.Results:   All patients have been able to good movement post‐operatively with the earliest contractions noted at one month post surgery. All patients had significant movement by three months post surgery. A number of patients have also been able to achieve some amount of spontaneous movement.Conclusions:   The nerve to masseter provides a highly reliable source of innervation for free muscle transfers and direct nerve transfer in older adults and children.