Nerve Switch for Reducing Synkinesis After Gracilis Muscle Transfer Innervated Via the Masseter Nerve

Background: In surgical treatment for longstanding facial paralysis, muscle transplantation is considered a useful and important method. To obtain a spontaneous smile, the use of the facial nerve of the healthy side as a motor source is better, but use of the masseter nerve allows prompt reinnervation and powerful movement. However, in some patients in whom the masseter nerve is used, separating masticatory movement and commissure contraction is difficult. Solutions for such patients have not been determined. Case History and Discussion: A 46-year-old female patient presented with longstanding complete facial paralysis after resection of a right acoustic neurinoma. As initial surgery, free gracilis transfer was performed on the cheek, but the patient experienced commissure movement during meals postsurgery. Secondary corrective surgery was performed to detach the motor nerve of the gracilis from the masseter nerve and suture it to the facial nerve of the healthy side via cross-face nerve graft. The symptom improved but partially recurred. Improvement in synkinetic movement can be obtained by performing cross-face nerve grafting and subsequent nerve switch. Address correspondence and reprint requests to Tomoyuki Ota, MD, Department of Plastic and Reconstructive Surgery, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama-shi, Okayama 700-8558, Japan; E-mail: hmwr327@gmail.com Received 16 April, 2018 Accepted 12 May, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2L26b7j