gms | German Medical Science

Objective: Unilateral and bilateral facial palsies resulting from the invasion of the facial nuclei and/or nerves are well known in lesions of the brainstem, cerebellopontine angle and the petrous bone. The aim of the study was to retrospectively analyze the functional outcomes of microneurovascular facial reanimation using 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 microneurovascular muscle transplantation using ipsilateral masseteric innervation. 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-indices could be observed in 8/17 patients (47%), an improvement in 7/17 (41%) and failure in 2/17 (12%). A natural smiling response was observed in 10/17 (59%) patients. Patients' self-evaluation scores were a level higher than objective indices.

Conclusions: Innervation of free microneurovascular muscle flaps with the masseteric nerve plays an important role in patients with lesions bringing forth a compromise of the facial nuclei. Synkinesis persists for long periods after surgery. However, most of the patients had learned to express their emotions by overcoming this phenomenon. Despite hyper or inadequate correction, patients evaluate themselves favourably.