Comparative Analysis of Masseteric Nerve Graft versus Cross-facial nerve Graft for facial reanimation. A Systematic Review

<title>Abstract</title> <p>Background: Facial palsy (FP) is the standard surgical approach for restoring facial symmetry and dynamic facial movement in patients with facial nerve paralysis (FNP). Among the available nerve transfer techniques, masseteric nerve transfer (MNT) and cross-facial nerve graft (CFNG) are the most frequently used; however, their comparative effectiveness remains uncertain because of variations in functional recovery, spontaneity of smile, and patient-reported outcomes. Objective: To evaluate and compare the clinical effectiveness of MNT and CFNT in patients undergoing facial reanimation (FR). Methods: This review involved vigorous search in several electronic databases for studies evaluating MNT and CFNG in patients with FNP. Two reviewers independently performed study. Methodological quality was assessed using the ROBINS-I tool. Results: Following rigorous search and selection, 6 studies met the predefined criteria and were included. Overall, MNT demonstrated faster functional recovery and better facial symmetry, whereas CFNG showed superior spontaneous smile restoration. Conclusions: MNT provides faster reinnervation and superior early functional recovery, whereas CFNG offers greater potential for spontaneous facial expression. Both techniques are effective for FR, and procedure selection should be customised based on patient characteristics, duration of paralysis, reconstructive goals, and surgeon expertise. (Prospero reg no:CRD420251244569)</p>