Masseter-to-facial nerve transfer: is it possible to rehabilitate the function of both the paralyzed eyelid and the oral commissure?

BACKGROUND

This report addresses the efficiency of masseter-to-facial nerve transfer and investigates the patient's ability to perform the functions of eyelid closure and smile movements independently.

METHODS

From November 2010 to January 2012, seven patients underwent the reported procedure and were followed 6 to 12 months postoperatively. The patients' ages varied from 22 to 41 years. The etiology of the injuries was resection of cerebellopontine angle tumors in all the patients. Using Terzis' and Mehta's scale, smile outcomes and synkinetic movements were evaluated pre- and post-operatively. The function of eyelid closure was evaluated by measuring the width of the lagophthalmos. A questionnaire was applied to evaluate ocular problems and donor-site morbidity.

RESULTS

All the patients were able to close their eyelids and smile with biting. Four of the seven patients were able to smile effortlessly without biting. According to Terzis' scale, the postoperative mean score was 4.3 ± 0.8 compared with 1.0 ± 0.0 at the preoperative evaluation. The improvement in the lagophthalmos varied from 2 to 5 mm. The ocular problems all were resolved. All the patients were able to smile easily without eyelid closure and could close their eyes with minimal oral commissure movement. No patients reported weakness of mastication on the affected side, and only minimal atrophy of the masseter muscle at the donor site was noted.

CONCLUSIONS

Masseter-to-facial nerve transfer is a highly efficient technique for reanimating paralyzed muscle. After physical training, both eyelid closure and smiling are restored and discriminated after physical training.

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