Salvage Procedures After Failed Facial Reanimation Surgery Using the Masseteric Nerve as the Motor Nerve for Free Functional Gracilis Muscle Transfer

ABSTRACT BACKGROUND: Neurofibromatosis type 2 (NF2) is a tumor suppressor syndrome defined by bilateral vestibular schwannomas. Facial paralysis, from either tumor growth or surgical intervention, is a devastating complication of this disorder and can contribute to disfigurement and corneal keratopathy. Historically, physicians have not attempted to treat facial paralysis in these patients. OBJECTIVE: To review our clinical experience with free gracilis muscle transfer for the purpose of facial reanimation in patients with NF2. METHODS: Five patients with NF2 and complete unilateral facial paralysis were referred to the facial nerve center at our institution. Charts and operative reports were reviewed; treatment details and functional outcomes are reported. RESULTS: Patients were treated between 2006 and 2009. Three patients were men and 2 were women. The age of presentation of debilitating facial paralysis ranged from 12 to 50 years. All patients were treated with a single-stage free gracilis muscle transfer for smile reanimation. Each obturator nerve of the gracilis was coapted to the masseteric branch of the trigeminal nerve. Measurement of oral commissure excursions at rest and with smile preoperatively and postoperatively revealed an improved and nearly symmetric smile in all cases. CONCLUSION: Management of facial paralysis is oftentimes overlooked when defining a care plan for NF2 patients who typically have multiple brain and spine tumors. The paralyzed smile may be treated successfully with single-stage free gracilis muscle transfer in the motivated patient.

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Facial reanimation with masseter nerve–innervated free gracilis muscle transfer in established facial palsy patients

Archives of Plastic Surgery ◽

10.5999/aps.2018.00717 ◽

2019 ◽

Vol 46 (2) ◽

pp. 122-128 ◽

Cited By ~ 6

Author(s):

Tae Suk Oh ◽

Hyung Bae Kim ◽

Jong Woo Choi ◽

Woo Shik Jeong

Keyword(s):

Facial Palsy ◽

Gracilis Muscle ◽

Muscle Transfer ◽

Facial Reanimation

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The Degree of Facial Movement following Microvascular Muscle Transfer in Pediatric Facial Reanimation Depends on Donor Motor Nerve Axonal Density

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000000860 ◽

2015 ◽

Vol 135 (2) ◽

pp. 370e-381e ◽

Cited By ~ 49

Author(s):

Alison K. Snyder-Warwick ◽

Adel Y. Fattah ◽

Leanne Zive ◽

William Halliday ◽

Gregory H. Borschel ◽

...

Keyword(s):

Motor Nerve ◽

Facial Movement ◽

Muscle Transfer ◽

Facial Reanimation ◽

Axonal Density

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Faculty Opinions recommendation of The degree of facial movement following microvascular muscle transfer in pediatric facial reanimation depends on donor motor nerve axonal density.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725334752.793544904 ◽

2018 ◽

Author(s):

Leslie Kim

Keyword(s):

Motor Nerve ◽

Facial Movement ◽

Muscle Transfer ◽

Facial Reanimation ◽

Axonal Density

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Restoration of Elbow Flexion With a Free Functional Gracilis Muscle Transfer in an Arthrogrypotic Patient Using a Motor Nerve to Pectoralis Major

Hand ◽

10.1177/1558944720923412 ◽

2020 ◽

Vol 15 (5) ◽

pp. NP80-NP84

Author(s):

Kristen M. Sochol ◽

George Edwards ◽

Milan Stevanovic

Keyword(s):

Medical Research ◽

Research Council ◽

Medical Research Council ◽

Motor Nerve ◽

Elbow Flexion ◽

Gracilis Muscle ◽

Pectoralis Major ◽

Muscle Transfer ◽

Motor Branch

Background: Patients with arthrogryposis may exhibit inability to flex the elbow. A free functional gracilis muscle transfer (FFGMT) can be used to restore elbow flexion. In our search of the available literature, we have not seen any descriptions of using a motor branch to the pectoralis major as a donor nerve to establish elbow flexion. Methods: We performed an FFGMT for restoration of elbow flexion in an arthrogrypotic patient with no active elbow flexion, who had a Medical Research Council (MRC) muscle grade of 0. Results: We report our 4.5-year outcomes. After undergoing an FFGMT for elbow flexion, our patient was able to gain an MRC grade 4 and achieve an arc of motion of 25° to 140°. Conclusion: An FFGMT for elbow flexion may be performed successfully using a motor branch to the pectoralis major.

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Hypoglossal-Facial Side-to-End Neurorrhaphy With Concomitant Masseteric-Zygomatic Nerve Branch Coaptation and Muscle Transfer for Facial Reanimation: Technique and Case Report

Operative Neurosurgery ◽

10.1093/ons/opaa128 ◽

2020 ◽

Vol 19 (3) ◽

pp. E230-E235

Author(s):

Nobutaka Yoshioka

Keyword(s):

Facial Nerve ◽

Facial Paralysis ◽

Mass Movement ◽

Nerve Transfer ◽

Nerve Graft ◽

Gracilis Muscle ◽

Muscle Transfer ◽

Nerve Branch ◽

Facial Reanimation ◽

Healthy Side

Abstract BACKGROUND Hypoglossal-facial direct side-to-end neurorrhaphy has become widely used for facial reanimation in patients with irreversible facial nerve damage. Although this procedure achieves good restoration of facial function, it has disadvantages such as mass movement and lack of spontaneity. OBJECTIVE To present a new facial reanimation technique using hypoglossal-facial direct side-to-end neurorrhaphy with concomitant masseteric-zygomatic nerve branch coaptation and secondary muscle transfer to reduce mass movement and achieve a spontaneous smile in patients with facial paralysis. METHODS This article describes a novel facial reanimation technique that employs hypoglossal and masseteric nerve transfer combined with secondary vascularized functional gracilis muscle transfer. RESULTS Details of the technique are reported in a patient with complete facial paralysis after brain surgery. The hypoglossal nerve was partially served and connected to the mastoid segment of the facial nerve by side-to-end anastomosis to restore facial symmetry. A nerve supplying the masseter muscle was coapted with a zygomatic branch by end-to-end anastomosis to restore voluntary movement of the oral commissure, as well as to assist with eye closure. A cross face sural nerve graft was connected to zygomatic branches on the healthy side. In the second stage, a vascularized functional gracilis muscle graft was transplanted using the cross face nerve graft as the donor nerve to restore a natural smile. CONCLUSION Hypoglossal-facial neurorrhaphy with concomitant masseteric-zygomatic nerve branch coaptation and muscle transfer is an alternative facial reanimation technique that reduces mass movement and achieves a natural smile.

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