A novel method to reconstruct the complex facial nerve defect after extended parotidectomy with masseteric nerve and descending hypoglossal nerve

This study aims to present a novel technique for reconstructing complex facial nerve defects using the masseteric nerve and descending hypoglossal nerve. Here, we report a case involving a patient with locally advanced parotid malignancy who underwent extended parotidectomy with resection of the invaded facial nerve. Following tumor resection, the proximal end of the facial nerve was inaccessible, leading to the formation of multiple distal branch defects. Subsequently, we performed reconstruction of the complex facial nerve defect using the masseteric nerve for the zygomatic and upper buccal branches and the descending hypoglossal nerve for the lower buccal and submandibular branches. There were no significant operative or post-operative complications observed. Upon 18 months of follow-up, the facial function of the patient had been restored to House-Brackmann-III grade. In conclusion, this dual nerve transposition approach proves to be an effective method for reconstructing complex facial nerve defects subsequent to extended parotidectomy.