Dual Innervation of Free Functional Muscle Flaps in Facial Paralysis

Michael J. Klebuc, Amy S. Xue, Andres F. Doval

Research output: Contribution to journalReview articlepeer-review

8 Scopus citations


Dual innervation in free muscle flap facial reanimation has been used to create a functional synergy between the powerful commissure excursion that can be achieved with the masseter nerve and the spontaneity that can be derived from a cross-face nerve graft. The gracilis has been the most frequently used muscle flap, and multiple combinations of neurorrhaphies have been described, including the masseter to the obturator (end-to-end) combined with a cross-face nerve graft to the obturator (end-to-side) and vice versa. Single and staged approaches have been reported. Minimally, dual innervation is as effective as using the motor nerve to masseter alone.

Original languageEnglish (US)
Pages (from-to)431-438
Number of pages8
JournalFacial Plastic Surgery Clinics of North America
Issue number3
StatePublished - Aug 2021


  • Cross-face nerve graft
  • Dual innervation
  • Facial paralysis
  • Free functional muscle flap
  • Nerve to masseter
  • Gracilis Muscle/transplantation
  • Free Tissue Flaps
  • Humans
  • Masseter Muscle/surgery
  • Smiling
  • Facial Paralysis/surgery

ASJC Scopus subject areas

  • Surgery


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