Experience with extraoral masseter muscle transposition in chronic facial paralysis

In the case of aged patients with chronic facial palsy with severe muscular atrophy, muscle transposition is a good alternative in order to supply som e form of movement. The masseter muscle may be transposed through either an intra- or extraoral approach. In the extraoral technique, most of the surg ical details have been well documented, except the relationships between th e masseter muscle and the parotid duct. Considering the anatomic direction of the parotid duct, a perfect axis of traction is available in order to li ft both lips and the buccal commissure. Ten cases of extraoral masseter mus cle transposition above the parotid duct were analyzed. Complete facial par alysis resulted from tumor extirpation (seven cases), arteriovenous malform ation (two cases) or trauma tone case). The patients' ages ranged from 47 t o 76 years with a median age of 60 years; seven patients were female and th ree male. The duration of the palsy prior to the muscle transposition, rang ed from 8 months to 18 years. The overall results were satisfactory in nine cases. Extraoral masseter muscle transposition is particularly attractive as a primary procedure, because of its efficiency in elderly patients with long-standing facial palsy. As a secondary procedure, masseter transpositio n may be considered as good an alternative for rehabilitation, when other r econstructive techniques have failed.