scholarly journals Dual-innervated multivector muscle transfer using two superficial subslips of the serratus anterior muscle for long-standing facial paralysis

2021 ◽  
Vol 48 (3) ◽  
pp. 282-286
Author(s):  
Hisashi Sakuma ◽  
Ichiro Tanaka ◽  
Masaki Yazawa ◽  
Anna Oh
Keyword(s):  
Facial Paralysis ◽  
Voluntary Contraction ◽  
Serratus Anterior Muscle ◽  
Upper Lip ◽  
Muscle Transfer ◽  
Serratus Anterior ◽  
Lower Lip ◽  
Fascia Lata Graft ◽  
Facial Reanimation ◽  
Double Muscle

Recent reports have described several cases of double muscle transfers to restore natural, symmetrical smiles in patients with long-standing facial paralysis. However, these complex procedures sometimes result in cheek bulkiness owing to the double muscle transfer. We present the case of a 67-year-old woman with long-standing facial paralysis, who underwent two-stage facial reanimation using two superficial subslips of the serratus anterior muscle innervated by the masseteric and contralateral facial nerves via a sural nerve graft. Each muscle subslip was transferred to the upper lip and oral commissures, which were oriented in different directions. Furthermore, a horizontal fascia lata graft was added at the lower lip to prevent deformities such as lower lip elongation and deviation. Voluntary contraction was noted at roughly 4 months, and a spontaneous smile without biting was noted 8 months postoperatively. At 18 months after surgery, the patient demonstrated a spontaneous symmetrical smile with adequate excursion of the lower lip, upper lip, and oral commissure, without cheek bulkiness. Dual-innervated muscle transfer using two multivector superficial subslips of the serratus anterior muscle may be a good option for long-standing facial paralysis, as it can achieve a symmetrical smile that can be performed voluntarily and spontaneously.

scholarly journals Revisiting Orthodromic Temporalis Transfer in Treating Long-Standing Facial Paralysis

2010 ◽  
Vol 3 (1) ◽  
pp. 17-23
Author(s):  
Amir S. Elbarbary ◽  
Mostafa Hemeda ◽  
Adel H. Amr
Keyword(s):  
Facial Paralysis ◽  
Simple Procedure ◽  
University Hospital ◽  
Temporalis Muscle ◽  
Muscle Transfer ◽  
The Past ◽  
Intraoral Approach ◽  
Good Movement ◽  
Fascia Lata Graft ◽  
Facial Reanimation

The treatment of long-standing facial paralysis through temporalis muscle transfer has stood the test of time. Herein, we present a modification in temporalis muscle transfer for lower facial reanimation. Instead of the traditional stripping of the temporalis muscle from its origin, its insertion is stripped from the coronoid process through an intraoral approach. The detached fibers were then sutured to a fascia lata graft, which was passed and secured to the orbicularis oris to reanimate the corner of the mouth. The procedure is less extensive and provides a direct “orthodromic” line of pull with good muscular excursion and power. This simple procedure has been applied to 12 consecutive cases with long-standing complete facial paralysis presenting to the Plastic and Reconstructive Surgery Clinic at the Ain-Shams University Hospital over the past 2 years. In addition to symmetry at rest, this easy procedure allowed for good movement of the corner of the mouth with restoration of a balanced smile.

Reconstruction of Lower Lip with Innervated Serratus Anterior Muscle Flap

2014 ◽  
Vol 30 (S 01) ◽  
Author(s):  
A. Gundeslioglu ◽  
Dem Özen ◽  
Lorenc Jasharllari ◽  
Nebil Selimolu ◽  
Figen Güney ◽  
...  
Keyword(s):  
Muscle Flap ◽  
Serratus Anterior Muscle ◽  
Serratus Anterior ◽  
Lower Lip

Facial Reanimation of Patients With Neurofibromatosis Type 2

2011 ◽  
Vol 70 (suppl_2) ◽  
pp. ons237-ons243 ◽  
Author(s):  
Kalpesh T. Vakharia ◽  
Doug Henstrom ◽  
Scott R. Plotkin ◽  
Mack Cheney ◽  
Tessa A. Hadlock
Keyword(s):  
Facial Paralysis ◽  
Neurofibromatosis Type ◽  
Neurofibromatosis Type 2 ◽  
Gracilis Muscle ◽  
Single Stage ◽  
Care Plan ◽  
Muscle Transfer ◽  
Facial Reanimation ◽  
Oral Commissure

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.

A Double‐Muscle Transfer using a Divided Rectus Femoris Muscle for Facial‐Paralysis Reconstruction

1997 ◽  
Vol 13 (03) ◽  
pp. 157-162 ◽  
Author(s):  
Isao Koshima ◽  
Naoto Umeda ◽  
Toru Handa ◽  
Takahiko Moriguchi ◽  
Yozo Orita
Keyword(s):  
Facial Paralysis ◽  
Rectus Femoris ◽  
Muscle Transfer ◽  
Double Muscle ◽  
Rectus Femoris Muscle ◽  
Femoris Muscle

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

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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