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Excerpt
The anatomic location of the motor nerve to the masseter muscle makes it an excellent choice for anastamosis to the buccal branch of the facial nerve for the treatment of selected cases of facial nerve injury. In addition, the close association between V nerve and VII nerve motor function around the upper mouth, used to advantage in masseter muscle transfers, supports such an anastamosis.
Background
Several cranial nerve-facial nerve transfers have been advocated for the treatment of facial nerve dysfunction; the most popular is the hypoglossal-facial nerve transfer. Less well known is a cranial nerve transfer that makes excellent theoretical sense but has not been widely used: anastomosis of the trigeminal branch to the masseter muscle with the facial nerve. The motor branch to the masseter lies in the muscle just below where the buccal branch of the facial nerve crosses the masseter. The size of these two nerve branches is similar and the potential for anastomosis excellent. The masseter motor nerve can also be anastomosed to the main trunk of the facial nerve. Very little clinical experience is available. Fisch has described successful trigeminal to facial nerve transfers, however these cases involved extensive surgery of the infratemporal space. The technique has also been used for the innervation of free muscle grafts in the treatment of mobius syndrome.
Methods
Four fresh cadavers were dissected to demonstrate the pertinent anatomy, feasibility of anastamosis, and surgical approach. A complete literature review was also performed.
Results
Using an extended face lift approach and elevating the masseter at the posterior-superior border, the anastomosis between the motor branch to the masseter and the buccal branch of the facial was surgically quite feasible. There was a size disparity between the main trunk of the facial nerve and the masseter motor nerve that could limit its use in this application.
Conclusions
This transfer deserves consideration as a corrective procedure for the rehabilitation of selected facial nerve injuries.
