Case reportRecycle of temporal muscle in combination with free muscle transfer in the treatment of facial paralysis
Section snippets
Background
To date, various static and dynamic procedures have been developed to treat long-standing facial paralysis. As for the cheek reanimation, tempolaris muscle transfer is widely accepted because of its efficiency with a relatively simple procedure, without any loss of other significant functions.1, 2 However, temporalis transfer does not give a spontaneous mimetic smile and necessitates physiotherapy to obtain automaticity.2 On the other hand, free neurovascular muscle transfer is known as an
Surgical methods
After removing a strip of skin above the eyebrow and performing a direct eyebrow lift, the cheek was undermined above the previously transferred temporalis muscle through a pre-auricular incision. In the present three cases, their caudally based rectangular temporalis muscle had been flipped over the zygomatic arch to the cheek pocket and the fascia lata was used as an intermediate graft to the lips. The dissection proceeded to about 1 cm beyond the nasolabial fold. In two of the three cases, a
Case 1
A 57-year-old woman suffered from established right complete facial paralysis after ablative surgery of an intracranial tumour 14 years ago. She had undergone dynamic smile reconstruction with a temporalis muscle transfer and static reconstructive operation for eyelid closure at another hospital. She visited us wanting to improve weak insufficient cheek smile motion that unpleasantly synchronised with bite action, incomplete right eyelid closure and obvious sagging of the eyebrow.
To obtain
Discussion
Our three patients complained of an unnatural cheek motion synchronised with biting. We therefore replaced the transferred temporalis muscle with the free neuromuscular latissimus dorsi muscle innervated by the contralateral facial nerve branch.6 Our present three cases may not be common, but we would like to point out the importance of the selection of the innervating source for smile reconstruction. Although Rubin et al. reported that some patients could obtain a spontaneous smile after
Conflict of interest/funding
None.
References (27)
Microneurovascular free muscle transplantation for reanimation of facial paralysis
Clin Plast Surg
(1979)- et al.
Cross-facial nerve grafts and microneurovascular free muscle transfer for long established facial palsy
Br J Plast Surg
(1980) Surgical treatment of lagophthalmos in leprosy by the gillies temporalis transfer
Br J Plast Surg
(1961)- et al.
Retrospective outcome analysis of temporalis muscle transfer for the treatment of paralytic lagophthalmos
J Plast Reconstr Aesthet Surg
(2009) Restoration of the blinking reflex in facial palsy by a simple lid-load operation
Br J Plast Surg
(1966)- et al.
One-stage reconstruction of facial paralysis associated with skin/soft tissue defects using latissimus dorsi compound flap
J Plast Reconstr Aesthet Surg
(2006) - et al.
Double innervation in free-flap surgery for long-standing facial paralysis
J Plast Reconstr Aesthet Surg
(2012) - et al.
Dual innervation method using one-stage reconstruction with free latissimus dorsi muscle transfer for re-animation of established facial paralysis: simultaneous reinnervation of the ipsilateral masseter motor nerve and the contralateral facial nerve to improve the quality of smile and emotional facial expressions
J Plast Reconstr Aesthet Surg
(2009) - et al.
Temporalis muscle for facial reanimation. A 13-year experience with 224 procedures
Arch Otolaryngol Head Neck Surg
(1993) - et al.
Temporalis muscle transfer for facial paralysis: a further refinement
Facial Plast Surg
(2000)