title: Masseteric-facial nerve anastomosis for early facial reanimation.
abstract: OBJECTIVE
  Early repair of facial nerve paralysis when cortical neural input cannot be provided by the facial nerve nucleus, is generally accomplished anastomozing the extracranial stump of the facial nerve to a motor donor nerve. That is generally the hypoglossus, which carries a variable degree of morbidity. The present work aims to demonstrate the effectiveness of the masseteric nerve as donor for early facial reanimation, with the advantage that harvesting is associated with negligible morbidity.
  
  
  METHODS
  Between October 2007 and August 2009, 7 patients (2 males, 5 women) with unilateral facial paralysis underwent a masseter-facial nerves anastomosis with an interpositional nerve graft of the great auricular nerve. The interval between the onset of paralysis and surgery ranged from 8 to 48 months (mean 19.2 months). All patients included in the study had signs of facial mimetic muscle fibrillations on electromyography. The degree of preoperative facial nerve dysfunction was grade VI following the House-Brackmann scale for all patients.
  
  
  RESULTS
  At the time of the study, all the patients with a minimum follow-up time of 12 months after the onset of mimetic function had recovered facial animation. Facial muscles showed signs of recovery within 2-9 months, mean 4.8 months, with the restoration of facial symmetry at rest. Facial movements appeared while the patients activated their chewing musculature. Morbidity related to this intervention is only the loss of sensitivity of earlobe and preauricular region.
  
  
  CONCLUSIONS
  The present technique seems to be a valid alternative to classical hypoglossal-facial nerve anastomosis because of similar facial nerve recovery and lower morbidity.
authors.affiliation: Department of Maxillo-Facial Surgery, Galeazzi Hospital, University of Milan, Italy. federico.biglioli@unimi.it
authors.forename: Federico
authors.initials: F
authors.lastname: Biglioli
authors.forename: Alice
authors.initials: A
authors.lastname: Frigerio
authors.forename: Valeria
authors.initials: V
authors.lastname: Colombo
authors.forename: Giacomo
authors.initials: G
authors.lastname: Colletti
authors.forename: Dimitri
authors.initials: D
authors.lastname: Rabbiosi
authors.forename: Pietro
authors.initials: P
authors.lastname: Mortini
authors.forename: Elena
authors.initials: E
authors.lastname: Dalla Toffola
authors.forename: Alessandro
authors.initials: A
authors.lastname: Lozza
authors.forename: Roberto
authors.initials: R
authors.lastname: Brusati
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D004431:Ear, External / Q000294:innervation; D005149:Facial Expression; D005154:Facial Nerve / Q000601:surgery*; D005158:Facial Paralysis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008406:Masseter Muscle / Q000294:innervation*; D008875:Middle Aged; D009416:Nerve Regeneration; D016067:Nerve Transfer / Q000379:methods; D010525:Peripheral Nerves / Q000637:transplantation*; D016896:Treatment Outcome; D055815:Young Adult