Subscribe to RSS
Changes in Electrical Activity of the Masseter Muscle and Masticatory Force after the Use of the Masseter Nerve as Donor in Facial Reanimation SurgeryFunding No funding was received for this article.
Introduction The masseter nerve has been used as a donor nerve for facial reanimation procedures due to the multiple advantages it offers; it has been generally considered that sacrifice of the masseter nerve does not alter the masticatory apparatus; however, there are no objective studies to support this claim.
Objective To evaluate the impact that the use of the masseter nerve in dynamic facial reconstruction has on the electrical activity of the masseter muscle and on bite force.
Materials and Methods An observational and prospective longitudinal study was performed measuring bite force and electrical activity of the masseter muscles before and 3 months after dynamic facial reconstructive surgery using the masseter nerve. An occlusal analyzer and surface electromyography were employed for measurements.
Results The study included 15 patients with unilateral facial paralysis, with a mean age of 24.06 ± 23.43. Seven patients were subjected to a masseter–buccal branch nerve transfer, whereas in eight patients, the masseter nerve was used as a donor nerve for gracilis free functional muscle transfer. Electrical activity of the masseter muscle was significantly reduced after surgery in both occlusal positions: from 140.86 ± 65.94 to 109.68 ± 68.04 (p = 0.01) in maximum intercuspation and from 123.68 ± 75.64 to 82.64 ± 66.56 (p = 0.01) in the rest position. However, bite force did not show any reduction, changing from 22.07 ± 15.66 to 15.56 ± 7.91 (p = 0.1) after the procedure.
Conclusion Masseter nerve transfer causes a reduction in electromyographic signals of the masseter muscle; however, bite force is preserved and comparable to preoperative status.
Keywordsmasseter muscle - bite force - facial paralysis - nerve transfer - electromyography - Bell’s palsy - masseter nerve - neurorrhaphy - gracilis muscle - free functional muscle transfer
Article published online:
28 April 2020
Thieme Medical and Scientific Publishers Private Limited
A-12, Second Floor, Sector -2, NOIDA -201301, India
- 1 Fattah A, Borschel GH, Manktelow RT, Bezuhly M, Zuker RM. Facial palsy and reconstruction. Plast Reconstr Surg 2012; 129 (02) 340e-352e
- 2 Coombs CJ, Ek EW, Wu T, Cleland H, Leung MK. Masseteric-facial nerve coaptation–an alternative technique for facial nerve reinnervation. J Plast Reconstr Aesthet Surg 2009; 62 (12) 1580-1588
- 3 Terzis JK, Noah ME. Analysis of 100 cases of free-muscle transplantation for facial paralysis. Plast Reconstr Surg 1997; 99 (07) 1905-1921
- 4 Biglioli F, Frigerio A, Rabbiosi D, Brusati R. Single-stage facial reanimation in the surgical treatment of unilateral established facial paralysis. Plast Reconstr Surg 2009; 124 (01) 124-133
- 5 Klebuc M, Shenaq SM. Donor nerve selection in facial reanimation surgery. Semin Plast Surg 2004; 18 (01) 53-60
- 6 Yoshioka N, Tominaga S. Masseteric nerve transfer for short-term facial paralysis following skull base surgery. J Plast Reconstr Aesthet Surg 2015; 68 (06) 764-770
- 7 Biglioli F, Colombo V, Tarabbia F. et al. Recovery of emotional smiling function in free-flap facial reanimation. J Oral Maxillofac Surg 2012; 70 (10) 2413-2418
- 8 Brenner E, Schoeller T. Masseteric nerve: a possible donor for facial nerve anastomosis?. Clin Anat 1998; 11 (06) 396-400
- 9 Klebuc M. The evolving role of the masseter-to-facial (V-VII) nerve transfer for rehabilitation of the paralyzed face. Ann Chir Plast Esthet 2015; 60 (05) 436-441
- 10 Hontanilla B, Cabello A. Spontaneity of smile after facial paralysis rehabilitation when using a non-facial donor nerve. J Craniomaxillofac Surg 2016; 44 (09) 1305-1309
- 11 Rich ME. Masseter muscle bite force in first bicuspid and collapsed occlusion cases. Int J Orthod Milwaukee 2012; 23 (02) 29-33
- 12 Telich-Tarriba JE, Contreras-Molinar C, Orihuela-Rodriguez A, Lesta-Compagnucci L, Carrillo-Cordova JR, Cardenas-Mejia A. Bite force and electromyographic activity of the masseter muscle in children with hemifacial microsomia. J Plast Surg Hand Surg 2019; 53 (05) 316-319
- 13 Hontanilla B, Marre D. Masseteric-facial nerve transposition for reanimation of the smile in incomplete facial paralysis. Br J Oral Maxillofac Surg 2015; 53 (10) 943-948
- 14 Yoshioka N. Masseter atrophication after masseteric nerve transfer. Is it negligible?. Plast Reconstr Surg Glob Open 2016; 4 (04) e692
- 15 Carter GM, Harkness EM. Alterations to mandibular form following motor denervation of the masseter muscle. An experimental study in the rat. J Anat 1995; 186 (Pt 3) 541-548
- 16 Telich-Tarriba JE, Velazquez E, Theurel-Cuevas A. et al. Upper extremity patterns of injury and management at a plastic and reconstructive surgery referral center in Mexico City. Ann Plast Surg 2018; 80 (01) 23-26
- 17 Ortega-Robles ED. Diseño y construcción de un sistema computarizado para el análisis de las fuerzas generadas entre los dientes superiores e inferiores durante la oclusión [Thesis]. Centro de Investigacion y Estudios Avanzados del Instituto Politecnico Nacional. Mexico City, Mexico: 2012
- 18 Borschel GH, Kawamura DH, Kasukurthi R, Hunter DA, Zuker RM, Woo AS. The motor nerve to the masseter muscle: an anatomic and histomorphometric study to facilitate its use in facial reanimation. J Plast Reconstr Aesthet Surg 2012; 65 (03) 363-366
- 19 Murphey AW, Clinkscales WB, Oyer SL. Masseteric nerve transfer for facial nerve paralysis: a systematic review and meta-analysis. JAMA Facial Plast Surg 2018; 20 (02) 104-110
- 20 Koc D, Dogan A, Bek B. Bite force and influential factors on bite force measurements: a literature review. Eur J Dent 2010; 4 (02) 223-232
- 21 Jian C, Wei M, Luo J. et al. Multiparameter electromyography analysis of the masticatory muscle activities in patients with brainstem stroke at different head positions. Front Neurol 2017; 8: 221