Masseteric-Facial Anastomosis: A Report of Three Cases

Intoduction The pathways of the facial nerve are variable, and knowledge of that is essential. The worst impact caused by facial paralysis is related to quality of life, especially regarding the self-esteem and social acceptance on the part of the patients, leading to social isolation and disruption on their mental health. Case Report A 33-year-old female patient, with a stage-T3 acoustic neurinoma, presented with a moderate dysfunction (grades II to III) according to the House- Brackmann (HB) Facial Nerve Grading System. A 43-year-old male patient, with a stage- T4B trigeminal schwannoma, underwent a resective surgery and presented grade-VI dysfunction according to the HB scale. And a female patient with a stage-T4A acoustic neurinoma presented grade-IV dysfunction according to the HB scale. Discussion We performed a literature review of papers related to surgeries for masseteric-facial nerve anastomosis and compiled the results in table; then, we compared these data with those obtained from our cases. Conclusion The masseteric nerve is the one that shows the best prognosis among all the cranial nerves that could be used, but it is also necessary to perform well the surgical technique to access the facial branch and consequently achieve a better masseteric-facial nerve anastomosis.

Masseter Muscle Reduction Using Radiofrequency Rhizotomy

Most Korean women prefer ovoid face to squared one and many female patients with squared face want to reduce their lower facial width. Mandibular angle ostectomy and botulinum toxin injection used to be the most common procedures performed to produce this purpose. After botulinum toxin, a series of non-invasive methods to reduce masseter muscle hypertrophy have been introduced. Radiofrequency rhizotomy was first used to treat chronic pain, such as, trigeminal neuralgia and showed good and long-lasting results. This concept of rhizotomy technique was then modified to block motor nerve conduction and used to treat motor dysfunction including painful spasticity. We tried this technique to reduce masseter hypertrophy by blocking the masseteric nerve using radiofrequency. From March 2007 to October 2007, 19 female patients underwent this masseter reduction using radiofrequency rhizotomy and follow-up period was 2 to 6 months. Most results showed reduction of masseter volume with improvement of lower facial contour and no significant complication occurred. The advantages of this method are safety, durability and cost-effectiveness and we think that this technique can be a good alternative method for treating masseter hypertrophy. But, longer follow-up periods and further studies are required to consolidate long-term results.