Comparative Efficacy of Masseteric-to-Facial Nerve Transfer with and without Fascia Lata Grafts in Reanimating Facial Paralysis.

BACKGROUND

Masseteric-to-facial nerve transfer excels in dynamic reanimation but is lacking in restoring baseline resting tone. Combining it with fascia lata grafts is expected to more fully enhance facial symmetry. Comprehensive comparison of the results of masseteric-to-facial nerve transfer versus combined static suspension may provide valuable insights into the most appropriate treatment for patients with subacute facial paralysis.

METHODS

In this retrospective study, 104 patients with facial paralysis were categorized by surgical procedure: 39 received masseteric-to-facial nerve transfer (group A), and 65 underwent transfer combined with a fascia lata graft (group B). The groups were further divided by oral commissure drooping, with severity graded as slight (A1, B1) or severe (A2, B2) asymmetry.

RESULTS

Patients in group B2 exhibited significantly better static symmetry than those in group A2, with improvements of 87.87% versus 40%, respectively (P < 0.001). No significant difference was observed between groups A1 and B1 in slight asymmetry. The Terzis Smile Function Grading System showed no dynamic symmetry differences (P > 0.05). On objective evaluation, postoperative outcomes indicated better static symmetry in both B groups, and improved dynamic symmetry in group A1, with no statistical difference between groups A2 and B2.

CONCLUSIONS

Masseteric-to-facial nerve transfer combined with fascia lata grafts significantly enhanced both static and dynamic symmetry for patients with varying degrees of asymmetry, particularly benefitting those with severe asymmetry. Patients with slight asymmetry who underwent the combined procedure achieved satisfactory static symmetry, although with a minor compromise of approximately 1 mm in dynamic symmetry compared with those who underwent masseteric-to-facial nerve transfer alone.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.