Salvage procedures after failed facial reanimation surgery using the masseteric nerve as the motor nerve for free functional gracilis muscle transfer.

Importance: Free muscle transfer innervated by a cross-facial nerve graft represents the criterion standard for smile reconstruction in facial paralysis. If primary reconstruction fails, a second muscle transfer is usually needed. Herein, we investigated the possibility of avoiding a second free muscle transfer by in situ coaptation of the gracilis muscle to the masseteric nerve.