The evolving role of the masseter-to-facial (V-VII) nerve transfer for rehabilitation of the paralyzed face.

In cases where the proximal stump of the facial nerve is unavailable for repair or interposition nerve grafting, and there are intact distal facial nerve branches and viable mimetic muscles, then the masseter-to-facial (V-VII) nerve transfer can provide an effective means of smile restoration. Positive attributes of the V-VII transfer include: limited donor site morbidity, anatomic consistency, a dense population of myelinated motor nerve fibers capable of producing strong motion, synergy with the facial nerve and potential for effective cerebral adaptation yielding an effortless smile. The technique can be utilized in isolation or combined with cross face nerve grafts to further enhance spontaneity and resting tone.