Journal of Plastic, Reconstructive & Aesthetic Surgery
Case ReportAn approach to bilateral facial paralysis
Section snippets
Method
We present a series of 20 patients with Complete Möbius syndrome that underwent bilateral reanimation from 1988 to 2006. 9 female and 11 male patients with a mean age of 18 yr (4–46 yr) at the time of operation.
All patients had a complete paralysis of both VIth and VIIth cranial nerves. Preoperatively all patients had clinical assessment of Trigeminal nerve function and electromyographic studies if there was any doubt as to its function.
Our approach has evolved from a bilateral Temporalis muscle
Results
There were no flap failures or significant complications in the series. The mean surgical time for the each staged procedure is 5 h, and 9 h for the bilateral procedure. All patients have been followed up for at least two years.
The Surgeon's Score was ‘excellent’ or ‘good’ in all patients. The Hay's Score in all cases was 9 preoperatively and averaged 2.8 postoperatively showing a significant improvement (p = 0.001, Paired T Test, Prism 5, GraphPad Software, USA) Figure 1. There was no significant
Discussion
We feel that a one-stage reconstruction produces results that are comparable with a staged procedure with no increase in complications. This minimises both the number of hospital admissions and general anaesthetics the patient is subjected to.
Our donor muscle of choice is the segmental Latissimus dorsi as described by MacKinnon.11 This can be harvested bilaterally with the patient supine through anterior axillary incisions allowing two teams to work concurrently on contralateral sides of the
Conflict of interest statement
None.
References (12)
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End-to-side neurorrhaphy with removal of the epineurial sheath: an experimental study in rats
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Cited by (27)
Restoring the spontaneous smile through free functional muscle transfer. A systematic review and meta-analysis of the last twenty years’ experience
2024, Journal of Plastic, Reconstructive and Aesthetic SurgeryWorkhorse Free Functional Muscle Transfer Techniques for Smile Reanimation in Children with Congenital Facial Palsy: Case Report and Systematic Review of the Literature
2021, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :The use of segmental latissimus dorsi and pectoralis minor transfer in children remains a controversial subject as the data are yet insufficient due to the small number of cases reported. Despite this, the outcomes are encouraging and a single-stage bilateral procedure using segmental latissimus dorsi muscles neurotized by the masseteric branch of the trigeminal nerve may be proposed as the procedure of choice in cases of bilateral facial paralysis 25. Rectus abdominis, serratus anterior, abductor hallucis brevis, and others are also described 24, but there is not enough evidence to support their use 1.
Facial Reanimation
2021, Plastic Surgery - Principles and PracticeFunctional outcomes assessment following free muscle transfer for dynamic reconstruction of facial paralysis: A literature review
2018, Journal of Cranio-Maxillofacial SurgeryMasseteric nerve transfer for short-term facial paralysis following skull base surgery
2015, Journal of Plastic, Reconstructive and Aesthetic SurgeryReanimation of the brow and eye in facial paralysis: Review of the literature and personal algorithmic approach
2015, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :In the acute phase, simple taping15 and lubrication may be adequate but once the condition is deemed permanent, surgical intervention may be required. We propose a step-by-step detailed approach to achieve this goal based on our experience of in excess of a thousand cases of facial paralysis.16–19 Many of the symptoms are age related and a child with facial palsy may not require any intervention at an early stage as they can compensate adequately with an intact protective Bell's phenomenon.