The nerve to masseter is commonly used to power the gracilis.
Other nerve options include: cross-facial nerve graft or the ipsilateral proximal facial nerve, when available.
The advantages of the masseteric nerve include: high motor neuron input and close proximity to the gracilis muscle (allowing direct nerve coaptation). This allows early, reliable, and strong reinnervation.
It is possible to use a combination of contralateral/ipsilateral facial nerve and masseteric nerve, in order to obtain strength of movement and spontaneity.
The masseteric nerve is identified within the body of the masseter muscle at the level of the sigmoid notch.
A nerve stimulator is used to confirm activity prior to nerve division and preparation for coaptation.