Postoperative Outcomes of Masseteric Nerve Transposition versus Cross-Facial Nerve Graft in Facial Reanimation: A Systematic Review and Meta-Analysis

Facial reanimation surgery offers various approaches, with the choice of method influenced by numerous factors. Masseteric nerve transposition (MNT) has become a preferred neural source, often compared with cross-face nerve graft (CFNG) for its respective advantages. This systematic review and meta-analysis aim to compare postoperative outcomes between MNT and CFNG in facial reanimation surgery for patients with facial nerve paralysis sequelae. A comprehensive electronic search was conducted using databases such as PubMed/Medline, Scopus, ScienceDirect, EBSCO, Web of Science, and Cochrane Library, along with gray literature sources like Scopus Preprints and MedRxiv. Statistical analyses were performed using Review Manager version 5.4.1, with the quality of included studies assessed using the Newcastle-Ottawa Scale. Results showed that MNT provided statistically significant improvements in commissural excursion (CE; mean difference [MD] = 2.36 mm) and commissural contraction velocity (CCV; MD = 7.01 mm/s) compared with CFNG. Additionally, MNT had a higher recovery percentage for CE (MD = 26.86%) and CCV (MD = 13.00%). Superior outcomes were also noted for static and dynamic smile symmetry, quality of life, and patient satisfaction. This meta-analysis underscores the advantages of MNT over CFNG in the majority of parameters in the analysis, at once highlighting the need for further research with larger sample sizes for more precise comparisons.