title: [Microneurovascular facial reanimation via the masseteric nerve: reconstruction alternative for long-standing facial palsy].
abstract: BACKGROUND
  The aim of the study was to retrospectively analyze the functional outcomes of microneurovascular facial reanimation using the masseteric innervation.
  
  
  METHODS
  Seventeen patients with irreparable facial paralyses 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. The results were analyzed by a commissural excursion (CE) index and a patient self-evaluation score. The presence of synkinesis was documented. Follow-up ranged from 8 to 48 months (mean 26.4 months).
  
  
  RESULTS
  Normalization of the CE index could be observed in 8 out of 17 patients (47%), an improvement in 7 out of 17 (41%) and failure in 2 out of 17 (12%). A natural smiling response was observed in 10 out of 17 (59%) patients. Patient 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 long-standing facial palsy (as in Möbius syndrome). Synkinesis persists for long periods after surgery. However, most of the patients had learned to express their emotions by overcoming this phenomenon. Despite hypercorrection or inadequate correction, patients evaluate themselves favorably.
authors.affiliation: Klinik und Poliklinik für Neurochirurgie, Johann Wolfgang von Goethe Universität, Schleusenweg 2-16, 60528 Frankfurt am Main, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Dützmann
authors.forename: G
authors.initials: G
authors.lastname: Marquardt
authors.forename: V
authors.initials: V
authors.lastname: Seifert
authors.forename: K G
authors.initials: KG
authors.lastname: Krishnan
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; D008875:Middle Aged; D012189:Retrospective Studies; D013703:Temporal Muscle / Q000294:innervation / Q000502:physiology / Q000637:transplantation*; D055815:Young Adult