Case Report
An approach to bilateral facial paralysis

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Summary

Möbius syndrome is characterised by a congenital paralysis of the Facial and Abducens nerves. Treatment centres around functional free muscle transfers. We present 20 cases of Möbius reanimation, currently the largest published series. Our preferred approach has evolved over time to be a single stage bilateral procedure using segmental Latissimus dorsi muscles driven by the masseteric branch of the Trigeminal nerve. All cases showed significant improvement when reviewed by the senior surgeon and independent panel of observers. It was the senior authors’ opinion that a more spontaneous smile was achieved in patients under ten years of age.

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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There are more references available in the full text version of this article.

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