Mimetic Neurotization from Masseter Muscle

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Abstract
The transposition of the masseter muscle into the acutely paralyzed face offers an excellent opportunity for returning movement to the region of the lips, cheek, and lower eyelid. This interdigitation of the masseter muscle with an intact nerve and blood supply into and through the multiple mimetic muscles of the middle third of the face, which have been freshly denervated and have an independent blood supply, establishes optimal physiologic conditions for neurotization. The raw surfaces of the split masseter muscle, with its intact axons, are in direct contact with the savaged mimetic muscles in the lips and cheek which have exposed degenerating axons. This intimate proximity induces axonal ingrowth into the adjacent empty neural tubules. The masseter muscle is implanted under stretching tension which may enhance the effect. There is no question that the regrowth phenomenon extends well beyond the immediate contact surfaces of these muscles into the interdigitating muscles of the face by the principle of collateral budding. Seventy-five such cases have been studied over the past thirty years, and the return of movement to the paralyzed face establishes this technique as an alternate method of rehabilitation in selected cases Use of the masseter muscle has proved to be a very effective method of rehabilitation of new and longstanding facial paralysis. Its prime effectiveness in acute paralysis is attributed to the neurotization of the paralyzed mimetic muscle system by the transposed and interdigitating living masseter muscle. When the facial muscles are severely atrophic it acts to suspend and move the area to which it is transposed about the cheek and lips. It is applicable in acute total facial paralysis when ipsilateral facial nerve grafting and hypoglossal facial anastomosis are not realistic. It is also effective in regional or segmental paresis about the lips and cheek. It may be useful in combination with ipsilateral facial nerve grafting and with temporal muscle transposition. It deserves consideration for facial rehabilitation in the high-risk patient undergoing radical resection of the facial nerve where a shortened operating time may be a factor. This great variety of potential indications makes it a useful alternate surgical technique in facial rehabilitation. It is a direct, simple procedure that provides support to the lips and commissure and neurotization to the middle third of the face in acute facial paralysis. It also has application as a delayed procedure in total or regional facial paralysis, in combination with other techniques and in intraoral transfer, and may, to some degree, contribute to muscle regeneration

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