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Sun Q, Li X, Zhu Z, Xiang X, Zhang T. Dynamic Repair Surgery for Late-Stage Facial Paralysis: Advances in Restoring Movement and Function. J Clin Med 2024; 13:4955. [PMID: 39201095 PMCID: PMC11355731 DOI: 10.3390/jcm13164955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 08/11/2024] [Accepted: 08/16/2024] [Indexed: 09/02/2024] Open
Abstract
Purpose: Facial paralysis results from congenital or acquired facial nerve damage, leading to significant cosmetic and functional deficits. Surgical resection of parotid and midface tumors can cause facial paralysis, necessitating effective treatment strategies. This review addresses the challenge of restoring movement and function in late-stage facial paralysis, focusing on dynamic repair techniques involving nerve and muscle transplantation. Methods: The review encompasses studies on dynamic repair surgery for late facial paralysis, including techniques such as local muscle flap with pedicle transfer, vascularized nerve flap with pedicle transfer, and multiple muscle flap procedures. A systematic literature search was conducted using PubMed, Web of Science, and Google Scholar, covering studies from 2000 to 2024. Keywords included "dynamic repair", "late-stage facial paralysis", "nerve and muscle transplantation", "muscle flap", and "tendon transposition". Included were clinical studies, systematic reviews, and meta-analyses reporting surgical outcomes. Exclusion criteria included studies with insufficient data and non-peer-reviewed articles. Results: Dynamic repair techniques involving nerve and muscle transplantation are essential for treating late-stage facial paralysis. Each surgical method has strengths and limitations. The masseter muscle flap demonstrates high success rates, although it can cause horizontal tension and jaw contour issues. The temporalis muscle flap is effective for smile restoration but may lead to temporal concavity. The gracilis muscle flap is widely used, especially with dual nerve innervation, showing high success in spontaneous smiles but requiring a longer recovery period. The latissimus dorsi flap is effective but can cause edema and shoulder issues. The serratus anterior free flap offers flexibility with precise vector positioning but may not achieve adequate lip elevation and can cause cheek swelling. Combined multi-flap surgeries provide more natural facial expressions but increase surgical complexity and require advanced microsurgical skills. Conclusions: Dual nerve innervation shows promise for restoring spontaneous smiles. One-stage surgery offers faster recovery and reduced financial burden. Comprehensive patient evaluation is crucial to select the most suitable surgical method. Dynamic repair techniques involving nerve and muscle transplantation provide effective solutions for restoring function and aesthetics in late-stage facial paralysis. Future research should focus on long-term outcomes, patient satisfaction, and standardizing surgical protocols to optimize treatment strategies.
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Affiliation(s)
- Qing Sun
- Division of Maxillofacial Surgery, Department of Stomatology, Peking Union Medical College Hospital & Chinese Academy of Medical Science, Beijing 100730, China; (Q.S.); (X.L.); (Z.Z.); (X.X.)
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital & Chinese Academy of Medical Science, Beijing 100730, China
| | - Xing Li
- Division of Maxillofacial Surgery, Department of Stomatology, Peking Union Medical College Hospital & Chinese Academy of Medical Science, Beijing 100730, China; (Q.S.); (X.L.); (Z.Z.); (X.X.)
| | - Zhihui Zhu
- Division of Maxillofacial Surgery, Department of Stomatology, Peking Union Medical College Hospital & Chinese Academy of Medical Science, Beijing 100730, China; (Q.S.); (X.L.); (Z.Z.); (X.X.)
| | - Xiting Xiang
- Division of Maxillofacial Surgery, Department of Stomatology, Peking Union Medical College Hospital & Chinese Academy of Medical Science, Beijing 100730, China; (Q.S.); (X.L.); (Z.Z.); (X.X.)
| | - Tao Zhang
- Division of Maxillofacial Surgery, Department of Stomatology, Peking Union Medical College Hospital & Chinese Academy of Medical Science, Beijing 100730, China; (Q.S.); (X.L.); (Z.Z.); (X.X.)
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Hohman MH, Krivda JS, Herr MW, Anderson KG, Bevans SE, Montgomery EA, Robitschek JM, Vincent AG. Composite Sterno-Omohyoid Functional Muscle Transfer for Dual-Vector Smile Reanimation: A Case Series. Facial Plast Surg Aesthet Med 2024; 26:418-423. [PMID: 37948552 DOI: 10.1089/fpsam.2023.0067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Background: Facial reanimation flaps often add bulk and produce single-vector smiles, and multivector flaps frequently require challenging intramuscular dissection. Objective: To evaluate the effectiveness of sterno-omohyoid flap (SOHF) transfer for dual-vector smile reanimation by measuring upper dental show and oral commissure movement. Methods: SOHF transfers from 2017 to 2020 were retrospectively evaluated using eFACE and Emotrics software. Results: Four patients with flaccid and one with nonflaccid facial paralysis were identified (four females and one male, median age: 39 years (range: 38-65); two acoustic neuromas, two congenital, one temporal bone fracture). Median follow-up was 20 months (range: 14-26). All flaps received masseteric nerves and two had additional cross-face grafts. Four developed contraction [median time to contraction: 5.5 months (range: 3-10)]. Mean oral commissure excursion and dental exposure improvements were 7.6 ± 4.0 mm (p = 0.03) and 2.9 ± 1.8 mm (p = 0.05), respectively. Dynamic, smile, and midface-smile eFACE improvements were 20.3 ± 6.8 (p = 0.007), 25.5 ± 14.5 (p = 0.03), and 50.5 ± 12.0 mm (p = 0.004) points, respectively. Mean SOHF mass was 14 ± 1.7 g. Conclusion: The SOHF is a small flap that provides dual-vector smile reanimation in flaccid and nonflaccid facial paralysis.
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Affiliation(s)
- Marc H Hohman
- Otolaryngology-Head & Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Joseph S Krivda
- Otolaryngology-Head & Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Marc W Herr
- Otolaryngology-Head & Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Kelly G Anderson
- Otolaryngology-Head & Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Scott E Bevans
- Otolaryngology-Head & Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Emily A Montgomery
- Otolaryngology-Head & Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jon M Robitschek
- Otolaryngology-Head & Neck Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Aurora G Vincent
- Otolaryngology-Head & Neck Surgery, Eisenhower Army Medical Center, Augusta, Georgia, USA
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Blasi M, Ribera À, de la Fuente J, Ayté T, Malagón P, Carrasco Lopez C, Higueras C. Masseteric Nerve Ultrasound Identification for Dynamic Facial Reanimation Purposes. Plast Reconstr Surg 2024; 154:175e-181e. [PMID: 37337339 DOI: 10.1097/prs.0000000000010871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND The masseteric nerve is one of the main options to neurotize free muscle flaps in irreversible long-term facial paralysis. Several preoperative skin-marking techniques for the masseteric nerve have been proposed to limit the surgical dissection area, shorten the surgical time, and enable a safer dissection. However, these have shown variability among them, and cannot visualize the nerve preoperatively. The authors designed an observational study to validate a high-frequency ultrasound (HFUS) nerve identification technique. METHODS A systematic HFUS examination was designed and performed to visualize the masseteric nerve in 64 hemifaces of healthy volunteers. One-third were randomly selected to undergo an additional HFUS-guided needle electrostimulation to validate the HFUS image. RESULTS The masseteric nerve was identified by HFUS in 96.9% of hemifaces (95% CI, 0.89 to >0.99) and showed almost perfect agreement with direct needle stimulation as calculated with Cohen kappa coefficient (0.95; 95% CI, 0.85 to 1.00). The masseteric nerve was found within the masseter muscle, in between the deeper muscle bellies, at 18.3 mm (SD ±2.2) from the skin. Only in 12.9% of cases (95% CI, 0.06 to 0.24) did its course become adjacent to the mandible periosteum. Other important features, such as disposition in relation to the parotid gland, or if the nerve was covered directly by a thick intramuscular aponeurosis, could be well observed by HFUS. CONCLUSION HFUS enables masseteric nerve identification and can provide the surgeon with specific information on anatomical relations for each examined individual before surgery.
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Affiliation(s)
- Marc Blasi
- From the Department of Plastic Surgery, Hospital Germans Trias i Pujol
| | - Àngels Ribera
- Physical Medicine and Rehabilitation Department, Hospital Universitari Germans Trias i Pujol
| | | | - Tomás Ayté
- From the Department of Plastic Surgery, Hospital Germans Trias i Pujol
| | - Paloma Malagón
- From the Department of Plastic Surgery, Hospital Germans Trias i Pujol
| | | | - Carmen Higueras
- From the Department of Plastic Surgery, Hospital Germans Trias i Pujol
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Boahene KDO. Commentary on: "Composite Sterno-Omohyoid Functional Muscle Transfer for Dual-Vector Smile Reanimation: A Case Series" by Hohman et al. Facial Plast Surg Aesthet Med 2024; 26:424-425. [PMID: 38112560 DOI: 10.1089/fpsam.2023.0301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Affiliation(s)
- Kofi D O Boahene
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Facial Nerve Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Dittmar JP, Schmiedl A, Bingöl A, Stögner V, Vogt PM, Krezdorn N. The Use of Plantaris Muscle Flap for Facial Reanimation: A Comprehensive Anatomical Study. Facial Plast Surg Aesthet Med 2023; 25:431-437. [PMID: 37074352 DOI: 10.1089/fpsam.2022.0268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Background: Functional facial reanimation remains challenging and the quest for optimization continues. Objective: To characterize the anatomical conditions of the plantaris muscle for facial reanimation. Study Design and Methods: Forty-two plantaris muscle specimens were obtained from 23 post-mortem chemically fixed cadavers. The muscles were dissected, evaluated, and measured. Mock facial reanimation was performed on three cadaver heads. Results: The plantaris muscle was a consistently available muscle. Mean muscle belly length was 10.1 cm (standard deviation [SD] 1.4), and mean width was 1.7 cm (SD 0.4). The mean tendon length of 30.1 cm (SD 2.8) is unique in the human body. The main artery supplying the muscle had a mean length of 1.4 cm (SD 0.4). The mean nerve length was 2.2 cm (SD 0.7). Sixteen variations of vascular supply were identified. Mock facial reanimations demonstrated a good size match, and great versatility of the long tendon for oral fixation. Conclusions: The plantaris muscle as a free flap for facial reanimation could offer new possibilities in terms of oral fixation and volumetric aesthetic conditions.
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Affiliation(s)
- Jan P Dittmar
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Andreas Schmiedl
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Alperen Bingöl
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Viola Stögner
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Peter M Vogt
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Nicco Krezdorn
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
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McKinnon VE, Riaz S, Stubbs E, McRae MH, McRae MC. Identification of the anatomy of the deep temporal vein using computed tomography imaging: A retrospective cross-sectional review of patient imaging. Microsurgery 2022; 42:757-765. [PMID: 36082800 DOI: 10.1002/micr.30956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/19/2022] [Accepted: 08/26/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE The deep temporal vein (DTV) can be used in free flap procedures when the superficial temporal vein is inadequate. Despite its potential utility, its branching patterns have only been examined in one small anatomic study. The purpose of this study was to examine computed tomography angiography (CTA) images to determine DTV location, variation, and suitability as a microvascular recipient, to provide surgeons with a guide for its use in head and neck defects. METHODS A retrospective chart review identified 152 patient CTA images (76 female; 76 male) in a single academic center imaging database, selected consecutively from January 2017 to April 2020. Patients under 19 years were excluded; ages ranged from 19 to 80 years (average 51.6 years). Reason for imaging, DTV caliber, laterality, distance to zygomatic arch (ZA [coronal and sagittal]), distance to lateral orbital rim (LOR), and branching pattern were recorded. RESULTS The predominant reason for imaging was to rule out cerebrovascular accident (96.2%). Average caliber was 3.46 ± 1.29 mm (95% confidence interval [CI] [3.32, 3.61]; range, 1.00-10.8). Bilateral DTVs were observed in 98.7% of patients. Average distance to landmarks were as follows: ZA (coronal), 13.8 ± 5.85 mm (95% CI [13.2, 14.5]; range, 2.7-33.8); ZA (sagittal), 15.1 ± 6.12 mm (95% CI [14.1, 16.1]; range, 2.8-47.2); LOR, 47.1 ± 9.09 mm (95% CI [46.0, 48.1]; range, 10.8-62.9). Seven branching patterns were identified, including a posterior vertical variant that bypasses the superficial temporal fat pad. CONCLUSIONS The DTV is a "lifeboat" option for head and neck reconstruction. Its average caliber is sufficient for use in microsurgery. Knowledge of both its typical and aberrant courses allow for efficient preoperative planning and surgical dissection. CTA is a useful adjunct when planning to use the DTV for free tissue transfer.
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Affiliation(s)
- Victoria E McKinnon
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Shaista Riaz
- Department of Diagnostic Radiology, McGill University, Montreal, Quebec, Canada
| | - Euan Stubbs
- Department of Diagnostic Imaging, McMaster University, Hamilton, Ontario, Canada
| | - Mark H McRae
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Matthew C McRae
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Suñé CH, López CC, López PM, Senosiain OG, Escribano MDR, Poyatos JV, Barceló LH, Alcázar ÀR, Carrera-Burgaya A, De la Torre FR, Martínez-Piñeiro A, Cabezas EA. The sternohyoid muscle flap for new dynamic facial reanimation technique: Anatomical study and clinical results. J Plast Reconstr Aesthet Surg 2021; 74:3040-3047. [PMID: 34020902 DOI: 10.1016/j.bjps.2021.03.085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 12/29/2020] [Accepted: 03/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Long-term facial nerve palsy has a highly negative impact on patients' quality of life. In 2016, Alam reported one case of facial reanimation with the sternohyoid muscle after publishing a preclinical study in 2013. Despite the potentially ideal characteristics of this muscle for reanimation of facial palsy, this technique is still not widely used. The objective of our description of cases was to present the clinical results obtained with the surgical procedure and the study on cadavers to confirm the anatomical findings. METHODS This work describes the anatomical study of the vascular and nervous pedicle of the sternohyoid muscle compared with clinical results from a series of patients with long-term facial paralysis who underwent facial reanimation between June 2016 and September 2019, through the insertion of the sternohyoid muscle into the masseteric nerve. RESULTS The anatomical study was conducted in eight human hemi-necks. In five cases (62%), the vascular pedicle was provided by the superior thyroid artery, and the entrance of the ansa cervicalis to the muscle was constant 1.8 cm from the distal insertion. This series included ten patients who underwent the surgery technique of facial reanimation using the sternohyoid muscle, with a 90% (n = 9) of reinnervation; 100% (n = 10) of flaps were viable, and none of the patients showed complications in the donor area. CONCLUSIONS The sternohyoid muscle showed itself as a reliable muscle as a free flap in facial reanimation, and alternative to the gracilis flap. The surgical technique was safe, without any complications, with excellent excursion, recovery, and aesthetic results.
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Affiliation(s)
- Carmen Higueras Suñé
- Plastic Surgery Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
| | | | - Paloma Malagón López
- Plastic Surgery Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Jordi Vilà Poyatos
- Plastic Surgery Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Lia Huesa Barceló
- Plastic Surgery Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Àngels Ribera Alcázar
- Rehabilitation Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Ana Carrera-Burgaya
- Department of Medical Sciences, Clinical Anatomy, Embryology and Neuroscience Research Group (NEOMA), School of Medicine, University of Girona, Girona, Spain
| | - Francisco Reina De la Torre
- Department of Medical Sciences, Clinical Anatomy, Embryology and Neuroscience Research Group (NEOMA), School of Medicine, University of Girona, Girona, Spain
| | | | - Emili Amilibia Cabezas
- Otorhinolaryngology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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A Novel Flap for Dynamic Reanimation of Facial Paralysis: Microvascular Sternohyoid Muscle Free Flap. J Oral Maxillofac Surg 2020; 79:925-931. [PMID: 33232659 DOI: 10.1016/j.joms.2020.10.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/24/2020] [Accepted: 10/24/2020] [Indexed: 11/22/2022]
Abstract
The main objectives of facial reanimation procedures include restoring facial symmetry at resting state and regaining facial mobility. Static procedures usually provide unsatisfactory results, especially in younger patients. For this reason, over the years, several different surgical alternatives based on autologous, locoregional, or muscle free flaps have been proposed. The gracilis muscle is the gold standard technique for dynamic reanimation of long-standing facial paralysis. The excessive muscle bulk and the differences regarding the type of predominant muscle fiber were compared with the zygomaticus major force reconstructive surgeons to search for alternatives to the gracilis as a potential free flap for reanimation. One of them is the sternohyoid muscle flap. We report a patient with long-standing facial paralysis who underwent a dynamic facial reanimation by using a sternohyoid muscle free flap, thus proposing the procedure as an alternative to the conventional gracilis muscle flap.
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Vincent AG, Bevans SE, Robitschek JM, Groom KL, Herr MW, Hohman MH. Sterno-omohyoid Free Flap for Dual-Vector Dynamic Facial Reanimation. Ann Otol Rhinol Laryngol 2019; 129:195-200. [DOI: 10.1177/0003489419875473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Dynamic rehabilitation of longstanding facial palsy with damaged, atrophied, or absent facial muscles requires replacement of neural and muscular components. The ideal reconstruction would include a fast-twitch muscle that is small, a reliable donor vessel and nerve, and the potential to provide a natural, synchronous, dentate smile with minimal donor site morbidity. Many flaps have been successfully used historically, but none has produced ideal rehabilitation. Objective: To evaluate the novel sterno-omohyoid, dual-vector flap in rehabilitation of chronic facial paralysis. Results: We performed sterno-omohyoid free tissue transfer for smile reanimation in a 39-year-old male with a history of longstanding right facial palsy following resection of a skull base tumor several years previously. We transferred both muscles with the superior thyroid artery, middle thyroid vein, and ansa cervicalis. The patient developed a dynamic smile by 6 months postoperatively, and he had improved objective facial symmetry. Conclusion: Herein, we demonstrate the first use of the sterno-omohyoid flap for successful facial reanimation. Overall, it is a novel flap in facial reanimation with many advantages over traditional flaps, including the potential to produce a more synchronous, dynamic smile while adding minimal bulk to the face. Future series will better elucidate the potential of the sterno-omohyoid flap.
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Affiliation(s)
- Aurora G. Vincent
- Otolaryngology—Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Scott E. Bevans
- Otolaryngology—Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, TX, USA
| | - Jon M. Robitschek
- Otolaryngology—Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, TX, USA
| | - Kelly L. Groom
- Otolaryngology—Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Marc W. Herr
- Otolaryngology—Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Marc H. Hohman
- Otolaryngology—Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA
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Abstract
The gracilis free flap is the ideal modality of emotive and spontaneous facial reanimation in patients with a viable contralateral facial nerve. A 2-stage procedure with a cross-face nerve graft followed by gracilis free flap inset is advocated. In this article, the anatomy of the gracilis muscle, alternative neural sources (including the masseteric nerve), and technical aspects of the procedure are discussed. The literature regarding outcomes and complications is reviewed.
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Affiliation(s)
- Babak Azizzadeh
- Department of Head and Neck Surgery, University of California, Los Angeles, 9401 Wilshire Boulevard #650, Westwood, Beverly Hills, CA 90212, USA.
| | - Kelly J Pettijohn
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS 62-237, Westwood, Los Angeles, CA 90095-1624, USA
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Temporalis Muscle Tendon Unit Transfer for Smile Restoration After Facial Paralysis. Facial Plast Surg Clin North Am 2016; 24:37-45. [DOI: 10.1016/j.fsc.2015.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Update in facial nerve paralysis: tissue engineering and new technologies. Curr Opin Otolaryngol Head Neck Surg 2015; 22:291-9. [PMID: 24979369 DOI: 10.1097/moo.0000000000000062] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW To present the recent advances in the treatment of facial paralysis, emphasizing the emerging technologies. This review will summarize the current state of the art in the management of facial paralysis and discuss the advances in nerve regeneration, facial reanimation, and use of novel biomaterials. This review includes surgical innovations in reinnervation and reanimation as well as progress with bioelectrical interfaces. RECENT FINDINGS The last decade has witnessed major advances in the understanding of nerve injury and approaches for management. Key innovations include strategies to accelerate nerve regeneration, provide tissue-engineered constructs that may replace nonfunctional nerves, approaches to influence axonal guidance, limiting of donor-site morbidity, and optimization of functional outcomes. Approaches to muscle transfer continue to evolve, and new technologies allow for electrical nerve stimulation and use of artificial tissues. SUMMARY The fields of biomedical engineering and facial reanimation increasingly intersect, with innovative surgical approaches complementing a growing array of tissue engineering tools. The goal of treatment remains the predictable restoration of natural facial movement, with acceptable morbidity and long-term stability. Advances in bioelectrical interfaces and nanotechnology hold promise for widening the window for successful treatment intervention and for restoring both lost neural inputs and muscle function.
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