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

Coombs, C.J.; Ek, E.W.; Wu, T.; Cleland, H.; Leung, M.K.

doi:10.1016/j.bjps.2008.05.046

« Previous Next »Journal of Plastic, Reconstructive & Aesthetic Surgery
Volume 62, Issue 12 , Pages 1580-1588, December 2009

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

C.J. Coombs
- Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Victoria, Australia
E.W. Ek
- Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Victoria, Australia
- Corresponding author. Tel.: +61 401 356 400; fax: +61 3 9887 8617.
T. Wu
- Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Victoria, Australia
- Corresponding author. Tel.: +61 401 356 400; fax: +61 3 9887 8617.
H. Cleland
- Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Victoria, Australia
M.K. Leung
- Department of Plastic and Reconstructive Surgery, The Alfred Hospital, Melbourne, Australia

Received 31 October 2007; accepted 20 May 2008. published online 08 October 2008.

Summary

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.

Results

Our axonal counts of the nerve to masseter have, on average, 1542±291.70 (SD) axons. Historical data have shown that the buccal branch of the facial nerve has 834±285 (SD) where the distal end of a cross-facial nerve graft has 100 to 200 axons. Our clinical use of the nerve to masseter as a direct nerve transfer in three patients based on these data has resulted in significant improvement in facial symmetry in repose (at a minimum of 1 year follow up), restoration of facial motion with occasional spontaneous activity and minimal synkinesis without any donor morbidity.

Conclusions

The advantages of this technique include the ease of dissection, constant and reliable anatomy, powerful reinnervation of the facial muscles without donor site morbidity and the potential for return of spontaneous facial movement.

Keywords: Masseteric nerve, Facial reanimation, Neurotisation, Cross-facial nerve graft