Masseteric-to-facial nerve transfer for treatment of pediatric facial paralysis: An initial report

• Published in: International journal of pediatric otorhinolaryngology 2022-06, Vol.157, p.111134-111134, Article 111134
• Main Authors: Marston, Alexander P., Ziegler, John P., Oyer, Samuel L.
• Format: Article
• Language: English
• Subjects: Adult; Child; Facial nerve; Facial Nerve - surgery; Facial paralysis; Facial Paralysis - surgery; Humans; Infant; Masseter Muscle; Masseteric-to-facial nerve transfer; Nerve Transfer - methods; Reconstructive Surgical Procedures; Retrospective Studies; Smiling - physiology
• ISSN: 0165-5876; 1872-8464
• DOI: 10.1016/j.ijporl.2022.111134

The indications and outcomes of masseteric-to-facial nerve transfer in pediatric patients with short-term facial paralysis is incompletely understood as compared to its use in adult patients. This report aims to retrospectively quantify outcomes with both clinician-based measurements and objective facial analysis software. Retrospective case series at a single institution. The Sunnybrook Facial Grading System was used for clinician-based measurements and Emotrics software for objective measurements. Four pediatric patients underwent masseteric-to-facial nerve transfers from 2016 to 2018. The mean patient age at the time of surgery was 4.5 years (range = 2–7) and the mean time from paralysis onset to surgical intervention was 12.9 months (range = 10.0–16.2). The mean follow-up was 18.3 months (range = 14.5–23.6). With regards to the Sunnybrook resting nasolabial fold symmetry, 3 of the 4 patients improved from 2 (absent nasolabial fold) to 1 (less pronounced nasolabial fold). Per the Emotrics analysis, the pre- and post-operative mean absolute differences for commissure excursion between the normal functioning and paralyzed sides were 11.8 mm and 6.7 mm, respectively (p = 0.04). The masseteric-to-facial nerve transfer technique leads to an objective improvement in dynamic smile function in select pediatric patients.