title: Salvage procedures after failed facial reanimation surgery using the masseteric nerve as the motor nerve for free functional gracilis muscle transfer.
abstract: OBJECTIVE
  Free muscle transfer innervated by a cross-facial nerve graft represents the criterion standard for smile reconstruction in facial paralysis. If primary reconstruction fails, a second muscle transfer is usually needed. Herein, we investigated the possibility of avoiding a second free muscle transfer by in situ coaptation of the gracilis muscle to the masseteric nerve.
  
  
  METHODS
  We report a series of 3 failed free muscle transfers for facial reanimation among 21 free flap transfers performed for facial reanimation between March 2008 and August 2013. To salvage the muscle, we performed coaptation of the neural pedicle from the cross-facial nerve graft to the masseteric nerve. This method allows for leaving the fixation sutures of the muscle at the oral commissure in place. All patients showed muscle contraction after 3 months and a smile with open mouth after 6 months. No significant difference in the range of commissure excursion was observed between the healthy and operated sides.
  
  
  CONCLUSIONS
  Recoaptation of the neural pedicle from the cross-facial nerve graft to the masseteric nerve, leaving the muscle transplant in place, is a suitable salvage procedure after unsuccessful reconstruction with a cross-facial nerve graft, avoiding a second free muscle transfer.
  
  
  METHODS
  4.
authors.affiliation: Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany.
authors.forename: Steffen U
authors.initials: SU
authors.lastname: Eisenhardt
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Tübingen, Germany.
authors.forename: Nils A
authors.initials: NA
authors.lastname: Eisenhardt
authors.affiliation: Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany.
authors.forename: Jan R
authors.initials: JR
authors.lastname: Thiele
authors.affiliation: Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany.
authors.forename: G Björn
authors.initials: GB
authors.lastname: Stark
authors.affiliation: Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Bannasch
mesh_terms: D005152:Facial Muscles / Q000294:innervation / Q000601:surgery; D005158:Facial Paralysis / Q000601:surgery*; D005260:Female; D058752:Free Tissue Flaps / Q000294:innervation / Q000637:transplantation*; D006801:Humans; D008406:Masseter Muscle / Q000294:innervation*; D008875:Middle Aged; D016067:Nerve Transfer / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D016879:Salvage Therapy / Q000379:methods*; D055815:Young Adult