Abstract
Masseteric-facial anastomosis has gained popularity in recent days compared to the facial–hypoglossal anastomosis. Masseteric nerve has numerous advantages like its proximity to the facial nerve, stronger motor impulse, its reliability, low morbidity in harvesting and sacrificing the nerve and faster re-innervation that is achievable in most patients. The present case series demonstrate the surgical technique and the effectiveness of the masseteric nerve as donor for early facial reanimation. Between January 2017 and February 2019, 6 patients (2 male, 4 female) with iatrogenic unilateral complete facial paralysis (grade VI, House Brackmann scale) who underwent masseteric-facial nerve anastomosis were included in the study. The time interval between the onset of paralysis and surgery ranged from 4 to 18 months (mean 8.5 months). In all patients pre-operative electromyography had facial mimetic muscle fibrillation potentials. All patients underwent end to end anastomosis except for one patient where greater auricular interposition graft was used. In all cases, the facial muscles showed earliest sign of recovery at 2–5 months. These movements were first noticed on the cheek musculature when the patients activated their masseter muscle. Eye movements started appearing at 6–9 months (in 3 cases) and forehead movements at 18 months (in 1 case). According to the modified House-Brackmann grading scale, one patient had Grade I function, two patients had Grade II function, and three had Grade V function. There was no morbidity except one patient who underwent interposition graft had numbness in the ear lobule. None of the patients could feel the loss of masseteric nerve function. Masseteric facial nerve anastomosis is a versatile, powerful early facial dynamic reanimation tool with almost negligible morbidity compared to other neurotization procedures for patients with complete facial nerve paralysis.
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References
Bayrak SB, Kriet JD, Humphrey CD (2017) Masseteric to buccal branch nerve transfer. Curr Opin Otolaryngol Head Neck Surg 25:280–285
Bianchi B, Ferri A, Ferrari S, Copelli C, Salvagni L, Sesenna E (2014) The masseteric nerve: a versatile power source in facial animation techniques. Br J Oral Maxillofac Surg 52:264–269
Biglioli F, Colombo V, Rabbiosi D, Tarabbia F, Giovanditto F, Lozza A, Cupello S, Mortini P (2017) Masseteric-facial nerve neurorrhaphy: results of a case series. J Neurosurg 126:312–318
Pitty LF, Tator CH (1992) Hypoglossal-facial nerve anastomosis for facial nerve palsy following surgery for cerebellopontine angle tumors. J Neurosurg 77:724–731
Viterbo F, Amr AH, Stipp EJ, Reis FJ (2009) End-to-side neurorrhaphy: past, present, and future. Plast Reconstr Surg 124:e351–e358
Venail F, Sabatier P, Mondain M, Segniarbieux F, Leipp C, Uziel A (2009) Outcomes and complications of direct end-to-side facial–hypoglossal nerve anastomosis according to the modified May technique. J Neurosurg 110:786–791
Biglioli F, Frigerio A, Colombo V, Colletti G, Rabbiosi D, Mortini P, Dalla Toffola E, Lozza A, Brusati R (2012) Masseteric-facial nerve anastomosis for early facial reanimation. J Craniomaxillofac Surg 40:149–155
Henstrom DK, Skilbeck CJ, Weinberg J, Knox C, Cheney ML, Hadlock TA (2011) Good correlation between original and modified House Brackmann facial grading systems. Laryngoscope 121:47–50
Terzis JK, Noah ME (1997) Analysis of 100 cases of free-muscle transplantation for facial paralysis. Plast Reconstr Surg 99:1905–1921
Murphey AW, Clinkscales WB, Oyer SL (2018) Masseteric nerve transfer for facial nerve paralysis: a systematic review and meta-analysis. JAMA Facial Plast Surg 20:104–110
Albathi M, Oyer S, Ishii LE, Byrne P, Ishii M, Boahene KO (2016) Early nerve grafting for facial paralysis after cerebellopontine angle tumor resection with preserved facial nerve continuity. JAMA Facial Plast Surg 18:54–60
Hontanilla B, Marré D (2012) Comparison of hemihypoglossal nerve versus masseteric nerve transpositions in the rehabilitation of short-term facial paralysis using the Facial Clima evaluating system. Plast Reconstr 130:662e–672e
Hu WL, Ross B, Nedzelski J (2001) Reliability of the Sunnybrook facial grading system by novice users. J Otolaryngol 30:208–211
Kahn JB, Gliklich RE, Boyev KP, Stewart MG, Metson RB, McKenna MJ (2001) Validation of a patient-graded instrument for facial nerve paralysis: the FaCE scale. Laryngoscope 111:387–398
Mehta RP, WernickRobinson M, Hadlock TA (2007) Validation of the synkinesis assessment questionnaire. Laryngoscope 117:923–926
Yoshioka N (2016) Masseter atrophication after masseteric nerve transfer. Is it negligible? Plast Reconstr Surg Glob Open 4:e692
Hontanilla B, Cabello A (2016) Spontaneity of smile after facial paralysis rehabilitation when using a non-facial donor nerve. J Craniomaxillofac Surg 44:1305–1309
Schaverien M, Moran G, Stewart K, Addison P (2011) Activation of the masseter muscle during normal smile production and the implications for dynamic reanimation surgery for facial paralysis. J Plast Reconstr Aesthet Surg 64:1585–1588
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [PS, GT, SR] and [CAS]. The first draft of the manuscript was written by [PS] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Sakthivel, P., Singh, C.A., Thakar, A. et al. Masseteric-Facial Nerve Anastomosis: Surgical Techniques and Outcomes—A Pilot Indian study. Indian J Otolaryngol Head Neck Surg 72, 92–97 (2020). https://doi.org/10.1007/s12070-019-01758-z
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DOI: https://doi.org/10.1007/s12070-019-01758-z