Experience with 11 Masseter-to-Facial Nerve Transfers Utilizing Fibrin Glue Alone for Coaptation

Background

Nerve transfer is the main reconstructive option for facial reanimation in short-term facial paralysis when the main trunk of the facial nerve is damaged, but distal nerve branches remain functional and mimetic muscles are still viable¹. The use of fibrin glue for peripheral nerve repair was relatively uncommon until the first commercially available fibrin sealant was introduced in the 1980s ^2,3. In this article we describe the use of fibrin sealant for nerve coaptation without sutures in masseter-to-facial nerve transfer; and the results obtained utilizing this technique in a series of eleven patients.

Methods

A retrospective review of the medical records of eleven patients with facial paralysis grades V-VI, who underwent masseter-to-facial nerve transfer for facial reanimation utilizing a fibrin sealant, without utilizing sutures for coaptation, was performed.

Results                                             

The follow up period ranged from 10 to 52 months. All patients recovered oral competence, eye closure, facial tone and a smile grade of 4,45 +/- 0,52 according to Terzis aesthetic and functional evaluation scale. Muscle contraction started 3-9 months postoperatively (average 4,7 +/- 2,3).

Conclusions

The use of fibrin glue without sutures for coaptation in masseter-to-facial nerve transfer, simplifies the procedure and shortens surgical timing, not requiring the material logistics of a microsurgical team, with similar results than coaptation performed with sutures. The masseter-to-facial nerve transfer is an effective technique for facial reanimation in short-term complete paralysis and mid-term partial paralysis.

1. Biglioli F, Frigerio A, Colombo V, et al. Masseteric-facial nerve anastomosis for early facial reanimation. J Craniomaxillofac Surg. 2012;40(2):149-155.

2. Egloff DV, Narakas A. Nerve anastomoses with human fibrin: Preliminary clinical report (56 cases). Ann Chir Main. 1983; 2:101–115.

3. Sameem M, Wood TJ, Bain JR. A systematicreviewon the use of fibrin glue for peripheral nerve repair. Plast Reconstr Surg. 2011;127(6):2381-2390.