Dual simultaneous systems for facial reanimation.

Successful reanimation of the paralyzed face requires a specific yet adaptable procedural armamentarium. Usually, in the treatment of regional paralysis, one distinct technique is deemed most appropriate and dependable. In cases of total hemiparesis secondary to surgical ablation or trauma, however, the simultaneous use of two separate but complementary rehabilitative systems has proved valuable in 15 patients. The reconstructive concept described divides the face into two functional spheres, an upper periorbital area and a lower perioral region. The integral system includes a direct facial nerve-to-cable graft reanastomosis for the upper division combined with a masseter muscle transfer for the lower facial region. The immediate supportive effects of the masseter transposition integrated with its long-term ability to rehabilitate via myoneurotization complement the more physiologically exacting effects of the nerve anastomosis.