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Intraoperative Distal Facial Nerve Stimulation Prior to Masseteric Nerve Transfer and Neurectomy 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 intraoperative stimulation of facial nerve branches from superior to inferior to produce a “map” of the facial nerve and identify branches that are candidates for nerve transfer and neurectomy. For a complete description of the technique, see the related article.

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