Dynamic facial reanimation in the elderly using masseteric-to-facial nerve transfer

Background: Masseteric-to-facial nerve (MTF) transfer offers the advantages of primary nerve coaptation, a high density of motor axons, and the potential connectedness between facial and trigeminal central cortical centres. Despite these benefits, its use in individuals aged greater than 60 years has not been widely described. Methods: A PubMed literature review from 1 January 1978 through to 31 December 2018 was performed to identify individuals older than 60 years who underwent a masseteric-to-facial nerve transfer. In addition, a retrospective chart review of all elderly patients who underwent a masseteric-to-facial nerve transfer at a single institution was conducted. Details on patient demographics, surgical techniques, outcomes and complications were recorded. Ethics approval for the study was obtained through the Monash Health Human Research Ethics Committee (RES-18-0000-768Q). Results: For the literature review, 12 out of 506 articles met the study criteria, with 28 patients identified and analysed. The average time to first facial movement was 5.5 months. Average improvement on oral commissure excursion was 11 mm. Of the eleven patients included in the clinical series, 27 per cent of patients experienced postoperative complications and there were no reported mortalities. Conclusion: Masseteric-to-facial nerve transfer is a safe and viable option for midface and perioral reanimation in the elderly with short term facial nerve palsies.