A Possible Expanded Timeline for Salvage Facial Reanimation Surgery: A Case Report

Background: Successful salvage facial reanimation procedures involving transfer of nerve to masseter (NTM) to an existing gracilis free muscle transfer (GFMT) have been reported when performed within 6 months. Methods: Medical records were reviewed for patients who had undergone a salvage or secondary facial reanimation surgery after an initial suboptimal GFMT by cross face nerve face graft (CFNG). Results: Between 2019-2024, three patients underwent salvage or secondary facial reanimation surgery after an initial procedure failed to produce movement by 11, 17 and 14 months respectively. Intraoperatively, the existing gracilis of patients 1 and 3 stimulated at 2mA and so a salvage procedure involving NTM transfer to the obturator nerve of the existing GFMT was performed. Successful smile was noted at 5 months for patient 1 and no facial movement after 12 months for patient 3. For patient 2, a secondary facial reanimation surgery (GFMT from the contralateral leg with innervation by the NTM) was performed due to lack of existing gracilis electrical stimulation and produced a successful smile noted at 7 months. Conclusions: This study demonstrates that successful salvage of a failed GFMT by CFNG is possible through transfer of the NTM to the obturator nerve even after 11 months.