Facial Nerve Reconstruction With Concurrent Masseteric Nerve Transfer and Cable Grafting.

IMPORTANCE: Reconstruction of the facial nerve after radical parotidectomy is commonly performed with cable grafting, which is associated with slow recovery of nerve function and synkinesis. OBJECTIVE: To describe facial nerve reconstruction after radical parotidectomy using concurrent masseteric nerve transfer and cable grafting. DESIGN, SETTING, AND PARTICIPANTS: This retrospective medical record review at a tertiary referral hospital included 9 patients who underwent concurrent masseteric nerve transfer and cable grafting for facial nerve reconstruction performed by a single surgeon from January 1, 2014, to October 31, 2015. Final follow-up was completed on March 14, 2016. MAIN OUTCOMES AND MEASURES: Improvement in resting facial symmetry and oral commissure excursion and synkinesis. RESULTS: Nine patients (6 women; mean age, 62.6 years; age range, 51-73 years) underwent immediate facial nerve reconstruction after radical parotidectomy using concurrent cable grafting and masseteric nerve transposition. All patients had return of oral commissure motion within 2 to 7 months after surgery with good excursion and minimal synkinesis. CONCLUSIONS AND RELEVANCE: Masseteric nerve transposition can be combined with cable grafting to improve outcomes in facial rehabilitation after radical parotidectomy. LEVEL OF EVIDENCE: 4.