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Original Investigation |

Facial Nerve Reconstruction With Concurrent Masseteric Nerve Transfer and Cable Grafting

James A. Owusu, MD1,2; Leni Truong, BS1; Jennifer C. Kim, MD1
[+] Author Affiliations
1Department of Otorhinolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
2Department of Otorhinolaryngology–Head and Neck Surgery, University of Texas Health Sciences Center at Houston
JAMA Facial Plast Surg. 2016;18(5):335-339. doi:10.1001/jamafacial.2016.0345.
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Importance  Reconstruction of the facial nerve after radical parotidectomy is commonly performed with cable grafting, which is associated with slow recovery of nerve function and synkinesis.

Objective  To describe facial nerve reconstruction after radical parotidectomy using concurrent masseteric nerve transfer and cable grafting.

Design, Setting, and Participants  This retrospective medical record review at a tertiary referral hospital included 9 patients who underwent concurrent masseteric nerve transfer and cable grafting for facial nerve reconstruction performed by a single surgeon from January 1, 2014, to October 31, 2015. Final follow-up was completed on March 14, 2016.

Main Outcomes and Measures  Improvement in resting facial symmetry and oral commissure excursion and synkinesis.

Results  Nine patients (6 women; mean age, 62.6 years; age range, 51-73 years) underwent immediate facial nerve reconstruction after radical parotidectomy using concurrent cable grafting and masseteric nerve transposition. All patients had return of oral commissure motion within 2 to 7 months after surgery with good excursion and minimal synkinesis.

Conclusions and Relevance  Masseteric nerve transposition can be combined with cable grafting to improve outcomes in facial rehabilitation after radical parotidectomy.

Level of Evidence  4.

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Figures

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Figure 1.
Combined Approach for Facial Nerve Reconstruction After Radical Parotidectomy

The cable nerve graft is illustrated in yellow; the masseteric nerve transfer, in green.

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Figure 2.
Outcome in Patient With High-Grade Mucoepidermoid Carcinoma

Movement of the oral commissure was noted at 3 months after combined facial nerve repair with improved facial symmetry and minimal synkinesis.

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Figure 3.
Outcome in Patient With High-Grade Salivary Duct Carcinoma

Movement of the oral commissure and facial symmetry were noted at 4 postoperative months.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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Multimedia

Video 1.

Woman With High-Grade Mucoepidermoid Carcinoma Who Underwent Combined Facial Nerve Repair

At postoperative month 5, improved nasolabial fold definition and lower eyelid tone, minimal oral commissure excursion with volitional smile, and obvious excursion on clenching are seen.

Video 2.

Man With High-Grade Salivary Duct Carcinoma Who Underwent Combined Facial Nerve Repair

At postoperative month 4, minimal commissure excursion with volitional smile and obvious excursion with clenching are seen.

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