Overview
The question was whether connecting the nerve of the masseter (a chewing muscle) to the facial nerve can restore movement to a paralyzed midface and mouth. The author reviewed 10 consecutive facial paralysis patients treated this way over 7 years. Patients were assessed by physical examination, direct measurement of how far the mouth corner moved, and video analysis.
Findings
- Retrospective review of 10 consecutive patients over a 7-year period.
- All patients regained oral competence, good resting tone and a smile.
- Smile vector and strength were comparable to those of the normal side.
- Motion developed an average of 5.6 months after the nerve transfer.
- 40 percent of patients developed an effortless smile by postoperative month 19.
- The author advocates the method for limited donor-site morbidity, no need for interposition nerve grafts, and the potential for cerebral adaptation.
What it means for a patient
- This paper is about restoring movement after facial paralysis, not about a cosmetic facelift.
- Movement does not return right away. In this series it began at an average of 5.6 months.
- By month 19, 4 in 10 patients could smile without conscious effort; the other 6 in 10 had not reached that point by then.
- Limits: 10 patients, a retrospective review, and a "select group" of paralysis patients, so results may not apply to every case.
Why this paper matters
It describes the masseter-to-facial nerve transfer as a method for reanimating the midface and mouth region and reports its results in a consecutive series. It adds a nerve source that avoids interposition nerve grafts. Cited 128 times (NIH iCite, 2026-09-25).
Terms
- Facial reanimation: surgery to restore movement to a paralyzed face.
- Masseter nerve: the motor nerve branch that powers the masseter, a jaw muscle used in chewing.
- Nerve transfer: connecting a working nerve to a nerve that has lost its input so it can drive the muscles again.
- Commissure excursion: how far the corner of the mouth moves during a smile.
- Oral competence: the ability to keep the lips sealed, holding in food, liquid and saliva.
- Interposition nerve graft: a piece of nerve taken from elsewhere to bridge a gap between two nerve ends.
- Donor-site morbidity: harm or loss of function where tissue is taken from.
- Cerebral adaptation: the brain learning to use a new nerve connection for a new movement.