Intraoral masseter muscle transposition: use with reconstruction of regional facial paralysis.

The treatment of regional facial paralysis of the lips and commissure by masseter muscle transposition is well accepted and usually accomplished by an external approach. The intraoral transfer demonstrates distinct advantages for the rehabilitation of midfacial regional paresis. The procedure is performed totally intraorally, which exposes the masseter muscle before transposing the anterior portion in a subcutaneous tunnel to the upper and lower lips. The effects of this transposition are direct support and immediate contraction, with eventual myoneurotization of the surrounding perioral musculature. The indications, operative considerations, and results in 22 cases are reported. This technique considerably advances the procedural approaches of the reconstructive surgeon and in used either in conjunction with other reconstructive modalities or as a primary procedure in selected cases.