Facial palsy is a life-changing disability. This can have an added impact on patients undergoing cancer surgery, both physically and mentally. Following their cancer treatment, most patients want to get back to normality and have a meaningful life filled with laughter, even if it is in their last remaining days. Masseteric nerve transfer has a vital role to bring back those smiles in their lives with minimal morbidity. Age, radiation and duration of palsy are often considered to have a negative impact on nerve regeneration. Facial nerve resection is sometimes required for cancer clearance, particularly in countries with a high incidence of skin cancer metastasis. These elderly patients often require postoperative radiation. We aim to study the influence of age, duration of palsy and postoperative radiation on facial nerve regeneration after masseteric nerve transfer surgery. This is a retrospective review of the use of masseteric nerve transfer for facial reanimation in a tertiary referral centre for head and neck cancer in New Zealand. Four elderly patients underwent masseteric nerve transfer in our institution successfully. Three of these patients even had postoperative radiation at the site of anastomosis. One patient with complete palsy with no sign of nerve regeneration on nerve conduction studies for 24 months before surgery had a good recovery of buccal movement to provide a meaningful smile. Masseteric nerve transfer has an important role to play in facial reanimation. Age, postoperative radiation and duration of palsy should not be considered contraindications for this procedure. When combined with other tightening procedures of the face, an excellent resting tone can be achieved.
