Now we are trying the following two new methods.
# 1
Neurovascular free muscle transfer is a widely accepted method to restore the smile of patients with established facial paralysis. To achieve better spontaneous and powerful movement by the transferred muscle, several issues, including the choice of the motor source nerve, have been discussed. Contralateral facial nerve branches can obviously provide a near-natural emotional smile by the transferred muscle. However, the power produced by the contralateral facial nerve is sometimes weak, resulting in asymmetry of the cheeks when smiling. The ipsilateral masseteric nerve, on the other hand, can produce powerful movement of the transferred muscle. However, the smile is not often spontaneous. To resolve this dilemma, we developed a new method in which the latissimus dorsi (LD) muscle is neurotized to both contralateral facial nerve branches and the ipsilateral masseteric nerve in one-stage.

# 2
One of the problems of the neurovascular free muscle transfer is that it can’t create the symmetrical nasolabial fold line. Conversely, Advantage of the masseteric nerve transfer which is indicated to the irreversible fresh paralysis is that it can restore a natural nasolabial fold line, impossible to create the involuntary smile although. Then, we combine the LD muscle neurotized by the contralateral facial nerve branches with the masseteric nerve transfer either to the fresh or established paralyzed face.

The key of these two methods is how the masseteric nerve should be used. The masseteric nerve should be used for the LD muscle as dual neurotized muscle? Or it should be used for the residual facial muscles as nerve transfer?
Conclusion is not achieved yet. In this presentation, operative procedures and some representative cases are shown.

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