title: Outcomes of microneurovascular facial reanimation using masseteric innervation in patients with long-standing facial palsy resulting from cured brainstem lesions.
abstract: BACKGROUND
  The functions of the human face are not only of esthetic significance but also extend into metaphoric nuances of psychology. The loss of function of one or both facial nerves has a remarkable impact on patients' lives.
  
  
  OBJECTIVE
  To retrospectively analyze the functional outcomes of microneurovascular facial reanimation using masseteric innervation.
  
  
  METHODS
  Seventeen patients with irreparable facial paralysis resulting from benign lesions involving the facial nuclei (n = 14) or Möbius syndrome (n = 3) were treated with free muscle flaps for oral commissural reanimation using ipsilateral masseteric innervation and using temporalis muscle transfer for eyelid reanimation. Results were analyzed by the absolute commissural excursion and commissural excursion index and by a patient self-evaluation score. Presence of synkinesis was documented. Follow-up ranged from 8 to 48 months (mean, 26.4 months).
  
  
  RESULTS
  Normalization of the commissural excursion index was observed in 8 of 17 patients (47%), an improvement was seen in 7 of 17 (41%), and failure was observed in 2 of 17 (12%). The individual dynamics of absolute commissural excursion and commissural excursion index changes are presented. A natural smiling response was observed in 10 of 17 patients (59%) but not in the remaining 7 (41%). This response reflected the patient's ability to relay the natural emotion of smiling through the masseteric nerve. Patients' self-evaluation scores were a level higher than objective indices.
  
  
  CONCLUSIONS
  Innervation of free muscle flaps with the masseteric nerve for oral commissure reanimation might play an important role in patients with lesions of the facial nuclei (as in Möbius syndrome). Synkinesis persists for long periods after surgery. However, most of the patients learned to express their emotions by overcoming this phenomenon. Despite hypercorrection or inadequate correction, patients evaluated themselves favorably.
authors.affiliation: Department of Neurosurgery, Center for Clinical Neurosciences, Johann Wolfgang Goethe University, Frankfurt, Germany. Kartik.Krishnan@med.uni-frankfurt.de
authors.forename: Kartik G
authors.initials: KG
authors.lastname: Krishnan
authors.forename: Gabriele
authors.initials: G
authors.lastname: Schackert
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
mesh_terms: D000293:Adolescent; D000328:Adult; D005152:Facial Muscles / Q000294:innervation / Q000503:physiopathology / Q000601:surgery*; D005155:Facial Nerve Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply / Q000294:innervation / Q000502:physiology*; D006801:Humans; D008297:Male; D008406:Masseter Muscle / Q000294:innervation / Q000502:physiology / Q000637:transplantation*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D013703:Temporal Muscle / Q000294:innervation / Q000502:physiology / Q000637:transplantation*; D055815:Young Adult