Facial reanimation using the masseter-to-facial nerve transfer.

BACKGROUND: This article describes facial reanimation using the transfer of the trigeminal motor nerve branch of the masseter muscle (masseter nerve) to the facial nerve (masseter-to-facial nerve transfer). METHODS: A retrospective review was performed of 10 consecutive facial paralysis patients treated with a masseter-to-facial nerve transfer for reanimation of the midface and perioral region over a 7-year period. Patients were evaluated with physical examination, direct measurement of commissure excursion, and video analysis. RESULTS: All patients regained oral competence, good resting tone, and a smile, with a vector and strength comparable to those of the normal side. Motion developed an average of 5.6 months after masseter-to-facial nerve transfer, with 40 percent of patients developing an effortless smile by postoperative month 19. CONCLUSIONS: The masseter-to-facial nerve transfer is an effective method for reanimation of the midface and perioral region in a select group of facial paralysis patients. The technique is advocated for its limited donor-site morbidity, avoidance of interposition nerve grafts, and potential for cerebral adaptation, producing a strong, potentially effortless smile.

How to help diabetic patients avoid amputation.

Preview Of the 14 million Americans who have diabetes mellitus, more than 2 million will at some point have foot ulcers. The prevalence of this complication, its impact on the activities of daily living, and the cost of treating it make it a problem of immense magnitude. Primary care physicians who emphasize prevention and early treatment of foot ulcers can greatly reduce the likelihood of serious sequelae. This article tells you what to look for in examining the feet, how to advise patients in foot care, and what to do if ulcers occur despite preventive efforts.