IDEAS AND INNOVATIONS
Masseter nerve as “baby sitter” procedure
in short-term facial paralysis
Received: 10 December 2009 / Accepted: 29 April 2010 / Published online: 21 May 2010
Abstract The classical “babysitter procedure” to maintain
the muscle tone of the affected paralyzed face using the
hypoglossal nerve was copied using the masseter nerve.
With this procedure, a nerve graft is not required and less
time is necessary to recover muscle tone.
Keywords Masseteric nerve
Facial paralysis produces a severe impact on the social and
emotional life of the patient. Reconstruction of the smile is
a very important objective in the surgical treatment of
patients with facial paralysis. Several procedures have been
described to obtain static and dynamic rehabilitation of the
paralyzed face [1–3]. Thus, direct neurotization of the
affected side of the face with the other ipsilateral nerve [4,
5], cross-facial nerve [6–8] and free muscle transfer for
dynamic reconstruction of the smile or laugh [9–12] are the
most popular methods for reconstruction of facial paralysis.
The reconstructive method is chosen in relation to the
length of time of denervation. Long-term denervation produ-
ces atrophy of the facial muscles. Thus, although the atrophied
muscles can be innervated, this will not obtain educated
motor function. In those cases, a free neurovascular muscle
transfer is a good option. In short-standing facial paralysis,
direct neurotization of the facial nerve or the use of a cross-
facial nerve graft (CFNG) may provide the best correction.
When using a CFNG, the facial nerve motor nucleus is
the same for both sides of the face. The problem with this
procedure is the long time necessary for the axons to grow
along the graft and the possibility of muscle atrophy. To
avoid this, Terzis, in 1984, described the “babysitter
procedure” using the hypoglossal nerve as a “babysitter”
. In this technique, the tone of the paralyzed hemiface is
maintained with the ipsilateral hypoglossal nerve connected
to the affected facial nerve for the time necessary to obtain
re-innervation, by the contralateral facial nerve through the
cross-interposed facial nerve.
In this article, we report an ipsilateral masseter nerve,
which could be connected directly to the facial nerve as a
“babysitter” procedure to avoid a nerve graft. We try to
preserve atrophy of the facial muscles using the masseteric
nerve. The advantage of this procedure is that the nerve is
long enough to be connected directly to the proximal upper
buccal branch of the facial nerve.
Material and methods
A 49-year-old man with a 9-month history of idiopathic
facial paralysis is presented. The masseter nerve was used
as a “babysitter procedure”. This “babysitter procedure”
consists of two surgical steps, which are performed with an
interval of 9 months between each stage. In the first stage,
two surgical procedures are combined. First, the buccal
branches of the unaffected hemiface are connected to the
sural nerve. The distal end of the sural nerve graft is left in
the paralyzed side. At the same procedure, an end-to-end
masseter-proximal buccal branch of the facial nerve is
performed without a nerve graft (Fig. 1).
Presented in EURAPS Congress in Barcelona May 29-30, 2009.
B. Hontanilla (*)
Departamento de Cirugía Plástica y Reparadora,
Clínica Universidad de Navarra,
31008 Pamplona, Spain
Eur J Plast Surg (2010) 33:227–229