Masseteric Facial Nerve Transfer (V-VII Transfer)
Patients who have had facial palsy for less than 2 years are generally candidates for the 5-7 nerve transfer, also known as the masseteric-facial nerve transfer (though there are a few exceptions to this rule), to restore their smile.
The masseteric nerve, also called the nerve to masseter (NTM), is a large nerve in the cheek which is used to activate the masseter muscle, a chewing muscle. In the 5-7 nerve transfer, a branch of the masseteric nerve is connected to a branch of the facial nerve which activates the smile muscles. After the nerves heal, the previously paralyzed smile muscles are controlled by simulating biting down. At the Facial Nerve Center, we have extensive experience with this procedure, allowing us to rapidly and reliably identify the masseteric nerve and the branch of the facial nerve most likely to maximize smile while minimizing unwanted facial movement, or synkinesis.
The 5-7 nerve transfer is performed under general anesthesia in the operating room. We make an incision in front of the ear similar incision to that used for face-lifting procedures. The facial nerve and masseteric nerves are identified and sewn together under microscopic magnification. Patients typically stay one night in the hospital and have a small drain in the wound. The drain is removed the morning after surgery and patients go home. Patients have stitches which are typically removed several weeks after surgery. After 3-6 months, patients will usually see first movement in their smile muscles on the affected side, when biting down or clenching the teeth. At that time, our facial nerve therapists can provide additional training to help patients learn how to smile with the new nerve hookup. With practice, many patients no longer have to think about biting when smiling.