Smile Reanimation with Masseteric-to-Facial Nerve Transfer plus Cross-Face Nerve Grafting in Patients with Segmental Midface Paresis: 3D Retrospective Quantitative Evaluation

Abstract

Facial paresis involves functional and aesthetic problems with altered and asymmetric movement patterns. Surgical procedures and physical therapy can effectively reanimate the muscles. From our database, 10 patients (18–50 years) suffering from unilateral segmental midface paresis and rehabilitated by a masseteric-to-facial nerve transfer combined with a cross-face facial nerve graft, followed by physical therapy, were retrospectively analyzed. Standardized labial movements were measured using an optoelectronic motion capture system. Maximum teeth clenching, spontaneous smiles, and lip protrusion (kiss movement) were detected before and after surgery (21 ± 13 months). Preoperatively, during the maximum smile, the paretic side moved less than the healthy one (23.2 vs. 28.7 mm; activation ratio 69%, asymmetry index 18%). Postoperatively, no differences in total mobility were found. The activity ratio and the asymmetry index differed significantly (without/with teeth clenching: ratio 65% vs. 92%, p = 0.016; asymmetry index 21% vs. 5%, p = 0.016). Postoperatively, the mobility of the spontaneous smiles significantly reduced (healthy side, 25.1 vs. 17.2 mm, p = 0.043; paretic side 16.8 vs. 12.2 mm, p = 0.043), without modifications of the activity ratio and asymmetry index. Postoperatively, the paretic side kiss movement was significantly reduced (27 vs. 19.9 mm, p = 0.028). Overall, the treatment contributed to balancing the displacements between the two sides of the face with more symmetric movements.