gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

A comparative evaluation of the innervation paths of the free functional muscle transplants used in the reanimation of the irreparably paralyzed face

Meeting Abstract

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  • K. Krishnan - Klinik für Neurochirurgie, Universitätsklinikum Frankfurt
  • G. Schackert - Klinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Dresden

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMO.14-04

doi: 10.3205/09dgnc100, urn:nbn:de:0183-09dgnc1008

Published: May 20, 2009

© 2009 Krishnan et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: We have reported on the role of the masseteric innervation of free functioning muscle flap (FFMT) used in the reanimation of the irreparably paralyzed face. In this report we conduct a comparative analysis of the outcomes obtained by using (a) the contralateral facial nerve and (b) the masseteric nerve for purposes of reinnervating the FFMT.

Methods: Twenty-six patients with irreparable unilateral complete facial nerve paralyses were included in the analysis. In all patients a FFMT (23x gracilis; 1x latissimus dorsi; 2x serratus anterior) was used for oral commissure reanimation. Among them the FFMT’s of 12 patients were innervated via the contralateral facial nerve, whereas in the remaining 14, the masseteric nerve was used for reinnervating the FFMT’s. To address the lid closure, all patients received a temporalis muscle transfer at the same or in a further sitting. The mean follow-up is 22 months (range: 12–48 months).

Evaluation criteria: The commissural excursion index (CEI), a dynamic system to monitor the level of excursion of the oral commissure and the self evaluating facial grading system were used.

Results: Use of the masseteric nerve showed clinical innervation of the gracilis flap within the first three months of follow-up in 13/14 patients. The CEI showed consistent normalization within 6 months of surgery in this group. However, a hypercorrection (supernormal innervation) was observed after one year in 8/14 patients. No downregulation was requested by the patients. Contrarily to these results innervation with the contralateral facial nerve showed prolonged times for muscle recovery. In 9/12 patients the CEI still showed levels below normal 1 year post-OP, whereas the remaining 3 showed complete failure in reinnervation of the FFMT. 3/26 patients requested additional weight implants for enhancement of eye-lid closure at later stages.

Irrespective of these objective results all patients showed high values of self evaluation.

Conclusions: Success in facial reanimation depends on the appropriate combination of method and technique of surgical treatment. Innervation of the free muscle flap through the masseteric nerve is quicker, and synkinesis is a relative phenomenon, which disappears with time.