About the Procedure
A masseter-to-facial (masseteric) nerve transfer is a procedure for facial paralysis that uses the nerve to the masseter chewing muscle as a new power source for the paralyzed facial muscles. It is used when the facial nerve is no longer functional but the facial muscles themselves remain viable, or in combination with a transferred muscle for smile reanimation.
The masseteric nerve provides a strong, reliable input that can produce a powerful smile. Because the nerve normally drives biting, patients initially activate the smile by gently clenching, and with practice many develop a more spontaneous smile over time.
At Norelle Health, the masseteric nerve transfer is selected based on the duration of paralysis, the condition of the facial muscles, and the patient's goals. It is frequently combined with other facial reanimation techniques as part of an individualized plan.
Who may be a candidate
Candidates generally have facial paralysis with facial muscles that are still viable, often when paralysis is relatively recent. The masseteric nerve can also serve as the power source for a transferred muscle, such as a gracilis muscle, in longer-standing paralysis.
Evaluation confirms that the facial muscles can still respond and that the masseteric nerve is functioning before this approach is recommended.
How it is performed
Through an incision in front of the ear, the surgeon identifies the facial nerve branches and the masseteric nerve, which lies within the chewing muscle. The masseteric nerve is connected to the facial nerve, often the branch that supplies the smile muscles.
When used with a muscle transfer, the masseteric nerve is connected to the nerve of the transplanted muscle. The procedure is performed under general anesthesia.
Considering masseter to facial nerve transfer? The next step is a quiet, unhurried conversation.
Recovery and aftercare
The incision in front of the ear is protected during early healing, and strenuous activity is limited for a short period. Movement does not appear right away.
As the nerve grows into the muscle over a few months, a smile begins to develop. Patients usually start by activating it with a gentle clench, and facial physical therapy helps strengthen the smile and work toward a more natural, spontaneous movement.
Risks and alternatives
Possible risks include incomplete movement, asymmetry, a smile that initially requires clenching, and standard surgical risks such as bleeding and infection. Effects on chewing are usually minimal because only part of the nerve is used.
Alternatives include other nerve transfers such as the hypoglossal nerve, a cross-face nerve graft, muscle transfer procedures for long-standing paralysis, and static or supportive measures.
Results and follow-up
Many patients regain a strong, reliable smile that develops over the first year and becomes easier to use with practice and therapy. Results vary, and some patients combine techniques to improve spontaneity and symmetry.
Follow-up monitors nerve recovery, supports rehabilitation, and addresses any need for additional refinement.
Considering masseter to facial nerve transfer? The next step is a quiet, unhurried conversation.
Medical review
This page is a patient-education resource reviewed by the responsible Norelle Health clinician before publication. It does not replace an in-person evaluation. If symptoms are severe or rapidly worsening, seek immediate medical care.
Candidacy & Evaluation
Recovery & Aftercare
Specialists who perform masseter to facial nerve transfer
Dr. Moustafa Mourad
MD, FACS
Double Board-Certified Head & Neck and Facial Plastic & Reconstructive Surgeon
Dr. Moustafa Mourad is a double board-certified head and neck and facial plastic and reconstructive surgeon who cares for the full range of cosmetic and complex conditions affecting the face, head, and neck.
- Facial plastic and reconstructive surgery
- Head and neck cancer surgery
- Microvascular free-flap reconstruction
- Facial trauma and reconstruction
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(212) 444-8006Frequently Asked Questions
It is a procedure that connects the nerve of a chewing muscle (the masseteric nerve) to the facial nerve to power paralyzed smile muscles, used when the facial nerve no longer works but the facial muscles are still healthy.
At first, the smile is activated by gently clenching the teeth, because the nerve normally drives chewing. With practice and therapy, many patients develop a smile that feels more automatic over time.
It is often used when facial paralysis is relatively recent and the facial muscles are still viable, or as the power source for a transferred muscle, such as a gracilis muscle, in longer-standing paralysis.
Effects on chewing are usually minimal because only a portion of the masseteric nerve is used and other chewing muscles remain. Significant long-term chewing problems are uncommon.
Smile movement typically begins to appear a few months after surgery as the nerve regrows into the muscle, and it strengthens over the following year with facial physical therapy.
Both reroute a working nerve to the facial nerve. The masseteric nerve gives a strong smile activated initially by clenching, while the hypoglossal transfer often supports resting tone; the two are sometimes combined.
Yes. It is frequently combined with a cross-face nerve graft or a muscle transfer, and with facial physical therapy, as part of an individualized facial reanimation plan.
Related Conditions
Related Procedures
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