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Intraoperative Facial Nerve Branch Identification Prior to Masseteric Nerve Transfer for Synkinetic Smile Rehabilitation

Synkinesis, the unintentional motion of one area of the face accompanying volitional movement of another, is common in patients with facial (Bell) palsy. A surgical technique involving masseteric-to-facial nerve transfer with selective neurectomy has been shown to provide significant smile improvement, with a long-term decrease in synkinesis for patients with facial palsy who have either failed botulinum toxin (Botox) therapy or who want to avoid regular injections. The technique requires distinguishing facial nerve branches producing the most aesthetically pleasing smile and the least synkinesis from branches causing synkinetic midface, oral, and ocular effects. This video demonstrates identification of a buccal nerve branch of the facial nerve with good smile excursion, a candidate for masseteric nerve transfer. For a complete description of the technique, see the related article.

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