Direct neurotization involves opening up the distal nerve fascicles and directly implanting the nerve into muscle to allow axonal sprouting at the muscle-nerve interface. In 2011, Terzis and Karypidis1 applied this technique to facial palsy and showed mild to moderate improvement with direct neurotization. Notably, their study avoided the use of the masseteric nerve, citing concerns for the risk of masticatory issues.
Kannan RY, Neville C, Gwynn T, Young K, Venables V, Nduka C. Evaluation of Masseteric Nerve–Based Selective Neurotization for Multivectorial Augmentation of the Weak Smile. JAMA Facial Plast Surg. Published online May 02, 201921(4):340–341. doi:10.1001/jamafacial.2019.0035
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