Research Article| Volume 65, ISSUE 8, P1002-1008, August 2012

The pedicled masseter muscle transfer for smile reconstruction in facial paralysis: Repositioning the origin and insertion

  • Author Footnotes
    d Authors contributed equally to this study.
    Damir B. Matic
    d Authors contributed equally to this study.
    Division of Plastic and Reconstructive Surgery, Department of Surgery, Western University, London, ON, Canada

    Division of Pediatric Surgery, Department of Surgery, Western University, London, ON, Canada
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  • Author Footnotes
    d Authors contributed equally to this study.
    John Yoo
    Corresponding author. London Health Sciences Center, Victoria Hospital, Room B3-433, 800 Commissioner's Road E., London, ON N6A 5W9, Canada. Tel.: +1 519 685 8500x57454; fax: +1 519 685 8457.
    d Authors contributed equally to this study.
    Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
    Search for articles by this author
  • Author Footnotes
    d Authors contributed equally to this study.
Published:April 04, 2012DOI:



      The pedicled masseter muscle transfer (PMMT) is introduced as a new reconstructive option for dynamic smile restoration in patients with facial paralysis. The masseter muscle is detached from both its origin and insertion and transferred to a new position to imitate the function of the native zygomaticus major muscle.


      Part one of this study consisted of cadaveric dissections of 4 heads (eight sides) in order to determine whether the masseter muscle could be (a) pedicled solely by its dominant neurovascular bundle and (b) repositioned directly over the native zygomaticus major. The second part of the study consisted of clinical assessments in three patients in order to confirm the applicability of this muscle transfer. Commissure excursion and vector of contraction following PMMT were compared to the non-paralyzed side.


      In all eight sides, the masseter muscles were successfully isolated on their pedicle and transposed on top of and in-line with the ipsilateral zygomaticus major. The mean length of the masseter and its angle from Frankfurt's horizontal line after transposition compared favorably to the native zygomaticus major muscle. In the clinical cases, the mean commissure movements of the paralyzed and normal sides were 7 mm and 12 mm respectively. The mean angles of commissural movement for the paralyzed and normal sides were 62° and 59° respectively.


      The PMMT can be used as a dynamic reconstruction for patients with permanent facial paralysis. As we gain experience with the PMMT, it may be possible to use it as a first-line option for patients not eligible for free micro-neurovascular reconstruction.


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        • Rubin L.R.
        The anatomy of a smile – its importance in the treatment of facial paralysis.
        Plast Reconstr Surg. 1974; 55: 384-387
        • Manktelow R.T.
        • Tomat L.R.
        • Zuker R.M.
        • et al.
        Smile reconstruction in adults with free muscle transfer innervated by the masseter motor nerve: effectiveness and cerebral adaptation.
        Plast Reconstr Surg. 2006; 118: 885-899
        • Michaelidou M.
        • Tzou C.-H.J.
        • Gerber H.
        • et al.
        The combination of muscle transpositions and static procedures for reconstruction in the paralyzed face of the patient with limited life expectancy or who is not a candidate for free muscle transfer.
        Plast Reconstr Surg. 2009; 123: 121-129
        • Lexer E.
        Muscle plastic for facial palsy.
        Korbl Allgartzl Verein Thuringen. 1911; 40: 185
        • Jianu A.
        Die chirurgishe behandlung der facialislachmung.
        Deutsch Z F Chir. 1909; 102: 377
        • Eden R.
        Ueber die chirurgische behandlung der peripherene facialislohmung.
        Beitr Klin Chir. 1911;
        • Halle M.
        The occurrence of facial paralysis and methods for its correction.
        Laryngoscope. 1938; 48: 225-235
        • Alexander R.J.
        Correction of facial paralysis by muscle transplant.
        Rocky Mt Med J. 1941; 38: 713
        • Conley J.
        Mimetic neurotization from masseter muscle.
        Ann Plast Surg. 1983; 10: 274-283
        • Zani R.
        • Castro Correia P.
        Masseter muscle rotation in the treatment of inferior facial paralysis – anatomic and clinical observations.
        Plast Reconstr Surg. 1973; 52: 370-373
        • Conley J.
        • Gullane P.J.
        The masseter muscle flap.
        Laryngoscope. 1978; 88: 605-610
        • Rubin L.R.
        Reanimation of total unilateral facial paralysis by the contiguous facial muscle technique.
        in: Rubin I.R. Reanimation of the Paralyzed Face. Mosby, St. Louis1991: 156-177
        • Miller S.H.
        • Wood A.M.
        Surgical treatment of facial nerve involvement caused by leprosy.
        Am J Trop Med Hyg. 1976; 25: 445-448
        • Morello D.C.
        • Converse J.M.
        Moebius syndrome – case report with a 30-year follow-up.
        Plast Reconstr Surg. 1977; 60: 451-453
        • Sawhney C.P.
        Reanimation of lower lip reconstructed by flaps.
        Br J Plast Surg. 1986; 39: 114-117
        • Maegawa J.
        • Saijo M.
        • Murasawa S.
        Muscle bow traction method for dynamic facial reanimation.
        Ann Plast Surg. 1999; 43: 354-358
        • Barabas J.
        • Klenk G.
        • Szabo G.
        • et al.
        Modified procedure for secondary facial rehabilitation following total bilateral irreversible peripheral facial palsy.
        J Craniofac Surg. 2007; 18: 169-176
        • Shinohara H.
        • Matsuo K.
        • Osada Y.
        • et al.
        Facial reanimation by transposition of the masseter muscle combined with tensor fascia lata, using the zygomatic arch as a pulley.
        Scand J Plast Reconstr Surg Hand Surg. 2008; 42: 17-22
        • Hwang K.
        • Kim Y.J.
        • Chung I.H.
        • et al.
        Course of the masseteric nerve in masseter muscle.
        J Craniofac Surg. 2005; 16: 197-200
        • Labbe D.
        • Huault M.
        Lengthening temporalis myoplasty and lip reanimation.
        Plast Reconstr Surg. 2000; 105: 1289-1297
        • Tate J.R.
        • Tollefson T.T.
        Advances in facial reanimation.
        Curr Opin Otolaryngol Head Neck Surg. 2006; 14: 242-248
        • Paletz J.L.
        • Manktelow R.T.
        • Chaban R.
        The shape of the normal smile: implications for facial paralysis reconstruction.
        Plast Reconstr Surg. 1994; 93: 784