Background: Facial paralysis can be debilitating and symmetrical facial muscle function is important for social interaction. I would like to present a case of right facial reanimation performed in Waikato Hospital.
Methods: This patient is a 76 year old gentleman who had severe Ramsay Hunt syndrome confirmed and had facial reanimation done 8 months later (June 2025).He presented in early October 2024 for complete right facial weakness, reduced hearing on the right, unsteady gait and vertigo. He went to have MRI scan a month later (November 2024), which confirmed post-contrast abnormal enhancement of the right facial nerve in its cisternal, meatus, geniculate ganglion, horizontal/tympanic and mastoid segments. In IAMs, there was also enhancement of the right superior vestibular and cochlea nerves. He was reviewed in clinic in May 2025, where he was found to have facial nerve palsy with no forehead sparing. The options discussed were masseter nerve transfer and digastric muscle transfer, continue clinical monitoring -leave the nerve to masseter to regenerate to see if he will recover.
Results: The patient was discharged postoperative day 1 and was seen by neurosurgery team for follow up. Six week follow up demonstrated near symmetry of the right face and 2/3 complete eye closure. Patient remained subjectively dissatisfied with the overall appearance. He is waiting for browlift, upper lid and lateral tarsorrhaphy.
Conclusion: Masseter nerve is favourable for facial reanimation due to its ease of dissection, close proximity to facial nerve and rapid functional recovery (1). In this case of delayed facial reanimation, the use of masseter nerve and digastric muscle transfer is proven to be an effective strategy. The case also highlights the multi stage nature if facial reanimation and the importance of managing patients' expectations.