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Bayezid KC, Morkuzu S, Karabulut E, Bajus A, Streit L. Restoring the spontaneous smile through free functional muscle transfer. A systematic review and meta-analysis of the last twenty years' experience. J Plast Reconstr Aesthet Surg 2024; 88:196-207. [PMID: 37988971 DOI: 10.1016/j.bjps.2023.10.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/04/2023] [Accepted: 10/23/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND The recovery of the spontaneous smile has become a primary focus in facial reanimation surgery and its major determinant is the selected neurotizer. We aimed to compare the spontaneity outcomes of the most preferred neurotization methods in free functional muscle transfer for long-standing facial paralysis. METHODS The Embase, Ovid Medline, and PubMed databases were queried with 21 keywords. All clinical studies from the last 20 years reporting the postoperative spontaneity rate for specified neurotization strategies [cross-face nerve graft (CFNG), contralateral facial nerve (CLFN), motor nerve to the masseter (MNM), and dual innervation (DI)] were included. A meta-analysis of prevalence was performed using Freeman-Tukey double arcsine transformation, I2 statistic, and generic inverse variance with a random-effects model. Risk Of Bias In Non-randomized Studies of Interventions and Newcastle-Ottawa scale were used to assess bias and study quality. RESULTS The literature search produced 2613 results and 473 unique citations for facial reanimation. Twenty-nine studies including 2046 patients were included in the systematic review. A meta-analysis of eligible data (1952 observations from 23 studies) showed statistically significant differences between the groups (CFNG: 0.94; 95% confidence interval [CI], 0.76-1.00, CLFN: 0.91; 95% CI, 0.49-1.00, MNM: 0.26; 95% CI, 0.05-0.54, DI: 0.98; 95% CI, 0.90-1.00, P < 0.001). In pairwise comparisons, statistically significant differences were found between MNM and other neurotization strategies (P < 0.001 in CFNG compared with MNM, P = 0.013 for CLFN compared with MNM, P < 0.001 for DI compared with MNM). CONCLUSIONS DI- and CLFN-driven strategies achieved the most promising outcomes, whereas MNM showed the potential to elicit spontaneous smile at a lower extent. Our meta-analysis was limited primarily by incongruency between spontaneity assessment systems. Consensus on a standardized tool would enable more effective comparisons of the outcomes.
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Affiliation(s)
- K Can Bayezid
- Department of Burns and Plastic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Plastic and Aesthetic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Suat Morkuzu
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell School of Medicine, Houston, TX, United States
| | - Erdem Karabulut
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Adam Bajus
- Department of Plastic and Aesthetic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Libor Streit
- Department of Burns and Plastic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Plastic and Aesthetic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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Millesi E, Suchyta M, Wang H, Mardini S. Anatomic Analysis of Masseteric-to-zygomatic Nerve Transfer in Rat and Pig Models. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5344. [PMID: 37859639 PMCID: PMC10584298 DOI: 10.1097/gox.0000000000005344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/21/2023] [Indexed: 10/21/2023]
Abstract
Background Nerve transfer from the masseteric branch of the trigeminal nerve is a widely performed procedure for facial reanimation. Despite achieving powerful muscle force, clinical and aesthetic results leave room for improvement. Preclinical animal models are invaluable to establishing new therapeutic approaches. This anatomical study aimed to establish a masseteric-to-zygomatic nerve transfer model in rats and pigs. Methods The masseteric branch of the trigeminal nerve and the zygomatic branch of the facial nerve were dissected in 30 swine and 40 rat hemifaces. Both nerves were mobilized and approximated to achieve an overlap between the nerve ends. Over the course of dissecting both nerves, their anatomy, length, and branching pattern were documented. At the coaptation point, diameters of both nerves were measured, and samples were taken for neuromorphometric analysis. Results Anatomic details and landmarks were described. Tension-free coaptation was possible in all rat and pig dissections. In rats, the masseteric branch had an average diameter of 0.36 mm (±0.06), and the zygomatic branch average diameter was 0.46 mm (±0.13). In pigs, the masseteric branch measured 0.52 (±0.16) mm and the zygomatic branch, 0.59 (±0.16) mm. No significant differences were found between the diameters and axon counts of both nerves in pigs. In rats, however, their diameters, axon counts, and fascicular areas were significantly different. Conclusion Our study demonstrated the feasibility of direct masseteric-to-zygomatic nerve transfer in rats and pigs and provided general anatomic knowledge of both nerves.
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Affiliation(s)
- Elena Millesi
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
- Division of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Marissa Suchyta
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
| | - Huan Wang
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minn
| | - Samir Mardini
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
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Sakuma H, Tanaka I, Yazawa M. Comparison of static and dynamic symmetry between masseter-innervated and dual-innervated free multivector serratus anterior muscle transfer for complete facial paralysis. J Plast Reconstr Aesthet Surg 2023; 82:107-117. [PMID: 37156105 DOI: 10.1016/j.bjps.2023.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 01/29/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE In this study, facial symmetry was compared between the masseter-innervated and dual-innervated free multivector serratus anterior muscle transfer (FMSAMT) methods. METHODS Eighteen patients with unilateral complete facial paralysis underwent facial reanimation surgery between April 2006 and July 2019. The masseter-innervated FMSAMT group (Group M, n = 8) underwent end-to-end coaptation with the ipsilateral masseter nerve in one stage. The dual-innervated FMSAMT group (Group D, n = 10) underwent end-to-end coaptation with the masseter nerve and end-to-side coaptation with the contralateral facial nerve via cross-face nerve graft. They were further divided into the one-stage (Group D1, n = 5) and two-stage (Group D2, n = 5) subgroups. The durations of periods until the first visible muscle contraction with clenching, first spontaneous smile, and the completion of resting tone were evaluated. The possibility of a spontaneous smile and symmetry of the midline and horizontal deviation at rest and during voluntary smiling were compared between each group. RESULTS Groups M and D differed significantly in the possibility of a spontaneous smile and improvement rate of midline deviation and horizontal deviation at rest (p < 0.001, p < 0.001, and p = 0.001, respectively) but not in the improvement rate of midline and horizontal deviation during voluntary smiling. The duration of the period until the completion of resting tone was significantly shorter in Group D1 than in Group D2 (p = 0.048); however, the possibility of a spontaneous smile and the improvement rate of midline and horizontal deviation were not significantly different. CONCLUSIONS Dual-innervated FMSAMT was effective in guaranteeing a symmetrical resting tone, voluntary smiling, and reproducing a spontaneous smile.
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Affiliation(s)
- Hisashi Sakuma
- Department of Plastic and Reconstructive Surgery, Ichikawa General Hospital, Tokyo Dental College, Ichikawa, Japan; Department of Plastic and Reconstructive Surgery, Yokohama Municipal Citizen's Hospital, Yokohama, Japan.
| | - Ichiro Tanaka
- Department of Plastic and Reconstructive Surgery, Ichikawa General Hospital, Tokyo Dental College, Ichikawa, Japan
| | - Masaki Yazawa
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
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Varman R, Miller MQ. Microvascular Gracilis Free Flap: Single and Double Innervation. Atlas Oral Maxillofac Surg Clin North Am 2023; 31:33-41. [PMID: 36754505 DOI: 10.1016/j.cxom.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Facial paralysis (FP) is a devastating condition that can lead to significant aesthetic, social, and emotional morbidities for patients. For some patients with FP, free gracilis muscle transfer (FGMT) is the best option for smile restoration. Masseteric-driven FGMT produces a reliable voluntary smile. Cross-face nerve graft-driven FGMT can produce a spontaneous smile, but this technique has higher failure rates. Early studies suggest dual-innervation FGMT can produce a spontaneous smile while maintaining the reliability of masseteric-driven procedures. Great care should be taken during FGMT surgery to minimize facial bulk and place medial inset sutures that create a natural-appearing smile.
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Affiliation(s)
- Rahul Varman
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Matthew Q Miller
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of North Carolina, Chapel Hill, NC, USA.
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Ferraresi S, Basso E, Maistrello L, Di Pasquale P. The Masseteric-Facial Anastomosis With Intratemporal Translocation of the Facial Nerve: Step-by-Step Technique and Results. Oper Neurosurg (Hagerstown) 2021; 21:360-370. [PMID: 34424333 DOI: 10.1093/ons/opab286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the absence of a viable proximal nerve stump, damaged after surgical procedures around the skull base, numerous techniques for facial reanimation have been developed over time, aiming to restore baseline symmetry and active mimicry. OBJECTIVE To report experience using the masseteric nerve as a direct transfer to the facial nerve rerouted after intratemporal translocation. This paper illustrates the main steps of the technique and the quality of results. METHODS Eleven patients were treated with a masseteric direct transfer to the facial nerve. Its extratemporal rerouting toward the zygoma allowed tension-free coaptation between donor and recipient nerves. RESULTS Of the 11 patients, 8 had a good to excellent recovery, showing different patterns of time and scores, according to age, surgical timing, and masseteric nerve function quality. The return of activity in the frontalis muscle, never obtained after reinnervation via the hypoglossal nerve, is of particular interest. The quality of the smile can be improved with re-education and practice but remains under volitional control. A true emotional response is still lacking. CONCLUSION The masseteric nerve is an excellent alternative to the hypoglossal nerve and can reinnervate the whole territory of the facial nerve rerouted after intratemporal translocation. The overall results are remarkable, but the low quality of the trigeminal nerve, eventually affected by the first surgery, may be an important limitation. Even if the patients appear more at ease in re-education than with other techniques, a fully natural facial expression remains impossible to obtain.
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Affiliation(s)
- Stefano Ferraresi
- Department of Neurosurgery, Ospedale S. Maria della Misericordia, Rovigo, Italy
| | - Elisabetta Basso
- Department of Neurosurgery, Ospedale S. Maria della Misericordia, Rovigo, Italy
| | - Lorenzo Maistrello
- Department of Neurosurgery, Ospedale S. Maria della Misericordia, Rovigo, Italy
| | - Piero Di Pasquale
- Neuroanesthesiology Unit, Department of Neurosurgery, Ospedale S. Maria della Misericordia, Rovigo, Italy
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Abstract
BACKGROUND Common donor nerve options in smile reanimation include ipsilateral trigeminal motor or contralateral facial nerve branches. Neurotization preference may be influenced by multiple factors, whose relative importance remains poorly understood. In this article, decision-making in smile reanimation is assessed using a stated preference model. METHODS Qualitative interviews with facial palsy patients identified five relevant attributes for study: smile type ("smile when biting" versus "smile spontaneously" as proxies for trigeminal versus cross-facial neurotization), number of operations, success rates, complication rates, and side effects. Community volunteers (n = 250) completed a discrete-choice experiment relevant to free muscle transfer for smile reanimation. Preoperative and postoperative states were demonstrated through video vignettes, together with explanation of surgical risks, consequences, and benefits. Attribute importance was modeled using hierarchical Bayes estimation. RESULTS Two hundred forty-one responses met quality controls. Attribute importance ranked as follows: chance of success, 37.3 percent; smile type, 21.4 percent; side effects, 13.9 percent; complication rates, 13.8; and number of operations, 13.6 percent. All attributes significantly correlated with decision making (p < 0.0001). An aggregate response model revealed most participants (67.6 percent; standard error, 3.0 percent) preferred smile reanimation by cross-facial (assuming a success rate of 80 percent) as opposed to ipsilateral trigeminal motor branch neurotization. When the success rate for cross-facial neurotization was reduced below 67 percent, trigeminal neurotization was preferred. CONCLUSIONS Despite a higher risk of failure, most respondents preferred a cross-facial as opposed to trigeminal neurotization strategy for smile reanimation. These findings highlight the complexity of decision-making and need for individualized risk tolerance assessment in the field of facial reanimation.
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Miller MQ, Hadlock TA. Lessons from Gracilis Free Tissue Transfer for Facial Paralysis: Now versus 10 Years Ago. Facial Plast Surg Clin North Am 2021; 29:415-422. [PMID: 34217444 DOI: 10.1016/j.fsc.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Outcomes following free gracilis muscle transfer have steadily improved during the past decade. Areas for continued improvement include re-creating natural smile vectors, improving midface symmetry, minimizing scarring, improving spontaneity, and increasing reliability using various neural sources. Outcome standardization, pooled data collection, and remote data acquisition methods will facilitate comparative effectiveness research and continued surgical advancements.
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Affiliation(s)
- Matthew Q Miller
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA, USA.
| | - Tessa A Hadlock
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA, USA
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Dual-innervated multivector muscle transfer using two superficial subslips of the serratus anterior muscle for long-standing facial paralysis. Arch Plast Surg 2021; 48:282-286. [PMID: 34024072 PMCID: PMC8143956 DOI: 10.5999/aps.2020.01599] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/03/2020] [Indexed: 11/14/2022] Open
Abstract
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.
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Tzafetta K, Al-Hassani F, Pinto-Lopes R, Wade RG, Ahmad Z. Long-term outcomes of dual innervation in functional muscle transfers for facial palsy. J Plast Reconstr Aesthet Surg 2021; 74:2664-2673. [PMID: 33853750 DOI: 10.1016/j.bjps.2021.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/20/2020] [Accepted: 03/13/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study describes a different approach with a 2-stage facial reanimation in patients with long-standing unilateral facial paralysis using free gracilis muscle transfer, innervated by both cross-facial nerve graft and masseteric nerve. The authors present their rationale, surgical technique, and long-term outcomes. METHODS Between August 2012 and March 2016, 11 patients (6 female and 5 male patients) underwent a 2-staged dually innervated gracilis muscle transfer. Patients were evaluated with physical examination and needle electromyography. A standardized assessment of preoperative and postoperative photographs and videos was performed using Terzis' smile functional grading system at 48 months following surgery and the Emotrics software to assess improvement in symmetry over a 36-month postoperative period. RESULTS Voluntary contraction of the gracilis muscle was observed in all patients at a mean of 4 months and 4 days following muscle transfer. A spontaneous smile produced without teeth clenching was developed in all patients by 18 months postoperatively. Six patients achieved excellent and 5 good results. The difference between the averaged pre- and postoperative scores was statistically significant. With Emotrics, there were significant improvements in the smile angle, upper lip elevation, commissural excursion, and commissural height, with continuous improvement over 36 months. The postoperative electromyography (EMG) confirmed dual innervation of the gracilis muscle by the facial and masseteric donor motor neural sources. We present our results at minimum 48 months postoperatively. CONCLUSIONS Dual innervated two-stage gracilis transfer is an effective method for reanimation in long-standing unilateral facial paralysis, providing both rapid reinnervation of the transferred muscle, together with a powerful, synchronous smile.
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Affiliation(s)
- Kallirroi Tzafetta
- St Andrews' Centre of Plastic and Reconstructive Surgery, Broomfield Hospital, Chelmsford, CM1 7ET, United Kingdom.
| | - Fawaz Al-Hassani
- St Andrews' Centre of Plastic and Reconstructive Surgery, Broomfield Hospital, Chelmsford, CM1 7ET, United Kingdom
| | - Rui Pinto-Lopes
- St Andrews' Centre of Plastic and Reconstructive Surgery, Broomfield Hospital, Chelmsford, CM1 7ET, United Kingdom
| | | | - Zeeshan Ahmad
- St Andrews' Centre of Plastic and Reconstructive Surgery, Broomfield Hospital, Chelmsford, CM1 7ET, United Kingdom
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Dual innervation of free gracilis muscle for facial reanimation: What we know so far. J Plast Reconstr Aesthet Surg 2020; 73:2196-2209. [DOI: 10.1016/j.bjps.2020.05.084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/01/2020] [Accepted: 05/19/2020] [Indexed: 11/20/2022]
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Fujii K, Matsumine H, Osaki H, Ueta Y, Kamei W, Niimi Y, Hashimoto K, Miyata M, Sakurai H. Accelerated outgrowth in cross-facial nerve grafts wrapped with adipose-derived stem cell sheets. J Tissue Eng Regen Med 2020; 14:1087-1099. [PMID: 32592279 DOI: 10.1002/term.3083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/11/2020] [Accepted: 06/15/2020] [Indexed: 12/12/2022]
Abstract
In this study, we devised a novel cross-facial nerve grafting (CFNG) procedure using an autologous nerve graft wrapped in an adipose-derived stem cell (ADSC) sheet that was formed on a temperature-responsive dish and examined its therapeutic effect in a rat model of facial palsy. The rat model of facial paralysis was prepared by ligating and transecting the main trunk of the left facial nerve. The sciatic nerve was used for CFNG, connecting the marginal mandibular branch of the left facial nerve and the marginal mandibular branch of the right facial nerve. CFNG alone, CFNG coated with an ADSC suspension, and CFNG wrapped in an ADSC sheet were transplanted in eight rats each, designated the CFNG, suspension, and sheet group, respectively. Nerve regeneration was compared histologically and physiologically. The time to reinnervation, assessed by a facial palsy scoring system, was significantly shorter in the sheet group than in the other two groups. Evoked compound electromyography showed a significantly higher amplitude in the sheet group (4.2 ± 1.3 mV) than in the suspension (1.7 ± 1.2 mV) or CFNG group (1.6 ± 0.8 mV; p < .01). Toluidine blue staining showed that the number of myelinated fibers was significantly higher in the sheet group (2,450 ± 687) than in the suspension (1,645 ± 659) or CFNG group (1,049 ± 307; p < .05). CFNG in combination with ADSC sheets, prepared using temperature-responsive dishes, promoted axonal outgrowth in autologous nerve grafts and reduced the time to reinnervation.
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Affiliation(s)
- Kaori Fujii
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hajime Matsumine
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hironobu Osaki
- Department of Physiology, Division of Neurophysiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshifumi Ueta
- Department of Physiology, Division of Neurophysiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Wataru Kamei
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yosuke Niimi
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuki Hashimoto
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Mariko Miyata
- Department of Physiology, Division of Neurophysiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Sakurai
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Amer TA, El Kholy MS, Khalaf AA, Rifky AM. Amer's classification of territories of facial nerve injury in early cases and strategies for the management of different territories. J Plast Reconstr Aesthet Surg 2020; 74:160-167. [PMID: 32631719 DOI: 10.1016/j.bjps.2020.05.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/31/2020] [Accepted: 05/19/2020] [Indexed: 11/17/2022]
Abstract
Early cases of facial nerve injury are best treated by restoring the neural pathway to the same existing facial muscles. Knowledge of the exact territory of facial nerve injury is required to design a plane for the reconstruction of these injuries and to compare results. The current study aims to design a classification system for territories of facial nerve injury based on the location of nearest healthy fascicles to the site of injury both proximally and distally. Two hundred-one patients with early facial nerve injury were assessed for treatment. According to the results of the exploration, 13 territories of injury were identified. The management strategy was planned according to the territory of injury. The current classification system is a simple, easy and effective method for the classification of territories of facial nerve injury. The classification system accurately describes the nearest possible healthy proximal and distal fascicles and can be employed to easily report cases and implement a management plan. This classification scheme also allows us to more effectively compare results.
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Affiliation(s)
- Tarek A Amer
- Department of Plastic Surgery, Faculty of Medicine, Cairo University, Egypt.
| | - Mohamed S El Kholy
- Department of Plastic Surgery, Faculty of Medicine, Cairo University, Egypt
| | - Amr Adel Khalaf
- Department of Plastic Surgery, Nasser Institute for Research and Treatment, Egypt
| | - Amr M Rifky
- Department of Plastic Surgery, Faculty of Medicine, Cairo University, Egypt
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Vila PM, Kallogjeri D, Yaeger LH, Chi JJ. Powering the Gracilis for Facial Reanimation: A Systematic Review and Meta-analysis of Outcomes Based on Donor Nerve. JAMA Otolaryngol Head Neck Surg 2020; 146:429-436. [PMID: 32215620 PMCID: PMC7099528 DOI: 10.1001/jamaoto.2020.0065] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/10/2020] [Indexed: 11/14/2022]
Abstract
Importance Free gracilis transfer for dynamic reanimation in chronic facial paralysis is the gold standard, but there remains a need to better understand outcomes with respect to the donor nerve. Objective To characterize outcomes in adults undergoing primary gracilis transfer for facial paralysis stratified by donor nerve used for neurotization. Data Sources Search strategies were used in Ovid MEDLINE (1946-2019), Embase (1947-2019), Scopus (1823-2019), Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov (1997-2019). Study Selection Inclusion and exclusion criteria were designed to capture studies in adults with unilateral chronic facial paralysis undergoing single-paddle free gracilis transfer. All study types were included except case reports. Abstracts and full texts were reviewed in duplicate. Of 130 unique citations, 10 studies including 295 patients were included after applying inclusion and exclusion criteria. Data were analyzed between November 2018 and December 2019. Data Extraction and Synthesis PRISMA guidelines were followed. The Newcastle-Ottawa scale was used to assess study quality, and the Cochrane Risk of Bias tool was used to assess risk of bias. Independent extraction by 2 authors (P.M.V. and J.J.C.) was performed. Data were pooled using a random-effects model. Main Outcomes and Measures Owing to heterogeneity in reporting of facial reanimation outcomes, we first performed a systematic review, and then compiled available outcomes for meta-analysis. Outcomes studied for meta-analysis were oral commissure excursion and facial symmetry. Results Meta-analysis of masseteric nerve (MN) (n = 56) vs cross-facial nerve graft (CFNG) (n = 52) in 3 retrospective studies showed no statistical heterogeneity between these studies (I2 = 0%), and the standardized mean difference (SMD) was greater for MN (0.55; 95% CI, 0.17 to 0.94). Meta-analysis of angles of symmetry in 2 retrospective studies comparing MN (n = 51) to CFNG (n = 47) both at rest (-0.22; 95% CI, -0.63 to 0.18) and with smiling (-0.14; 95% CI, -0.73 to 0.46) were better with MN, though the difference was not statistically significant. Conclusions and Relevance Owing to heterogeneity in reported outcomes from facial reanimation, we were unable to make definitive conclusions regarding the optimal donor nerve. Establishing a reporting standard at peer-reviewed journals to improve results reporting is one method to allow for improved collaboration in the future. Standardizing follow-up times, assessing spontaneity in an objective and reproducible fashion, and use of consistent outcome measures would allow for future meta-analyses and better understanding of options for facial reanimation.
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Affiliation(s)
- Peter M. Vila
- Department of Otolaryngology–Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology–Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Lauren H. Yaeger
- Bernard Becker Medical Library, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - John J. Chi
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology–Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
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Trotman CA, Faraway J, Hadlock TA. Facial mobility and recovery in patients with unilateral facial paralysis. Orthod Craniofac Res 2020; 23:82-91. [PMID: 31529611 PMCID: PMC11218815 DOI: 10.1111/ocr.12346] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/02/2019] [Accepted: 09/11/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE (a) To quantify longitudinal 3D changes in facial soft tissue movements in adults with unilateral facial paralysis, and (b) to compare the patients' movements with an age- and sex-frequency matched control group. SETTINGS AND SAMPLE POPULATION Prospective 3D facial movement data of 36 patients and 68 control participants. Patients' data were collected within 6 weeks of onset of symptoms (baseline) and then at 3 and 12 weeks after baseline. MATERIALS AND METHODS The 3D facial movement data were collected during different facial animations. Mean group measurements of displacement, velocity and asymmetry were computed. Two sample t tests were used to test for significant group differences, and linear mixed models were fit to test for significant changes over time in the patient group. Also, 3D dynamic modelling and vector plots were computed to isolate the patients' abnormal movements and/or paralysis. RESULTS The patients' mean baseline movements were significantly less for both the paralysed and contralateral sides of the face with much greater movement asymmetry than the controls. Patients' mean measures improved significantly from baseline to 12 weeks. The measures were closer to, but fell short of, the control values. CONCLUSION In unilateral facial paralysis, the contralateral facial side was affected by the paralysis and may be tethered or limited in its movement by the paralysed side. The comprehensive measurement set and 3D facial mapping effectively tracked patient recovery and isolated paralysed facial regions. The 3D measures can be used for diagnosis and outcome assessment of different treatments.
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Affiliation(s)
- Carroll Ann Trotman
- Department of Orthodontics, Tufts University School of Dental Medicine, Boston, MA, USA
| | - Julian Faraway
- Department of Mathematical Sciences, University of Bath, Bath, UK
| | - Tessa A. Hadlock
- Department of Otolaryngology, Facial Nerve Center, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Oyer SL, Nellis J, Ishii LE, Boahene KD, Byrne PJ. Comparison of Objective Outcomes in Dynamic Lower Facial Reanimation With Temporalis Tendon and Gracilis Free Muscle Transfer. JAMA Otolaryngol Head Neck Surg 2019; 144:1162-1168. [PMID: 30325983 DOI: 10.1001/jamaoto.2018.1964] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Facial paralysis affects patients' physical, social, and psychological function. Dynamic smile reanimation can mitigate these effects, but there are limited data to guide the surgeon in selecting the best reanimation procedure for each patient. Objective To compare quantitative changes in oral commissure symmetry and smile excursion following temporalis tendon transfer (T3) and gracilis free muscle transfer. Design, Setting, and Participants Retrospective case series of 28 adults with unilateral facial paralysis seeking dynamic lower facial reanimation at a tertiary academic medical center between July 1, 2010, and July 30, 2014. Data were analyzed from May 1, 2016, to June 30, 2016. Interventions Minimally invasive T3 (n = 14) compared with gracilis free muscle transfer (n = 14). Main Outcomes and Measures Measured symmetry of the oral commissure between the healthy and paralyzed sides in the horizontal, vertical, and angular dimension and excursion of the paralyzed commissure following reanimation compared with the healthy commissure. Results Of the 28 patients, 19 (68%) were women; mean (SD) age was 51.7 (17) years. Commissure symmetry during smile improved significantly for the T3 patients in the vertical and angular dimensions, and the gracilis free muscle transfer patients had significant improvement in the vertical and horizontal dimensions. Commissure excursion significantly improved in both groups following surgery, with a larger improvement seen in the gracilis free muscle transfer group (11.3 mm; 95% CI, 7.0 to 15.5 mm) compared with the T3 group (4.8 mm; 95% CI, 0.2 to 9.3 mm), with a mean difference of 6.5 mm (95% CI, 0.7 to 12.4 mm; Cohen d, 0.86). Postoperative smile excursion of the paralyzed side was within 1.0 mm of the healthy side in the gracilis free muscle transfer group (95% CI, -2.1 to 4.0 mm). Conclusions and Relevance Temporalis tendon transfer and gracilis free muscle transfer both improve oral commissure symmetry and excursion in facial paralysis. The improvement in smile excursion appears to be larger in patients treated with gracilis free muscle transfer and, on average, the excursion approximates the contralateral healthy side.
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Affiliation(s)
- Samuel L Oyer
- Facial Plastic & Reconstructive Surgery, Department of Otolaryngology, Medical University of South Carolina, Charleston
| | - Jason Nellis
- Facial Plastic & Reconstructive Surgery, Department of Otolaryngology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Lisa E Ishii
- Facial Plastic & Reconstructive Surgery, Department of Otolaryngology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Kofi D Boahene
- Facial Plastic & Reconstructive Surgery, Department of Otolaryngology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Patrick J Byrne
- Facial Plastic & Reconstructive Surgery, Department of Otolaryngology, Johns Hopkins Hospital, Baltimore, Maryland
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Murphey AW, Clinkscales WB, Oyer SL. Masseteric Nerve Transfer for Facial Nerve Paralysis: A Systematic Review and Meta-analysis. JAMA FACIAL PLAST SU 2019; 20:104-110. [PMID: 29222560 DOI: 10.1001/jamafacial.2017.1780] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Importance A review of the role of masseteric nerve transfer is needed to guide its use in facial reanimation. Objective To systematically review the available literature, and, when applicable, analyze the combined outcomes of masseteric nerve transfer to better define its role in reanimation and to guide further research. Data Sources Two independent researchers conducted the review using PubMed-NCBI and Scopus literature databases for studies on masseteric nerve transfer for facial nerve paralysis. Study Selection Studies that examined masseter nerve transfer with additional cranial nerve transposition/coaptation or muscle flap were excluded. Data Extraction and Synthesis Literature review and data extraction followed established PRISMA guidelines. Two researchers extracted data independently. Main Outcomes and Measures The main planned outcomes for the study were quantitative results of facial nerve movement after nerve transfer including oral commissure movement and time to nerve recovery. Results A total of 13 articles met inclusion criteria with a total of 183 patients undergoing masseteric nerve transfer. From those studies, there were a total of 183 patients who underwent masseteric nerve transfer. There were 85 men and 98 women with a mean (SD) age of 43 (12.2) years and mean (SD) follow up examination after surgery of 22 (7.6) months. Mean (SD) duration of nerve paralysis was 14 (6) months. Most common cause of paralysis was cerebellopontine angle tumors (81%). Six studies coapted the masseteric nerve to the main facial nerve trunk, whereas 7 used distal branches (buccal or zygomatic). Four studies used interposition nerve grafts with great auricular nerve. Two measures, improvement in oral commissure excursion and length from reanimation to facial movement, were measured consistently across the studies. Pooled analysis showed time from surgery to first facial movement, described in 10 studies, to be 4.95 months (95% CI, 3.66 to 6.24). Distal branch coaptation improved time to recovery vs main branch coaptation, 3.76 vs 5.76 months (95% CI, -0.33 to 4.32), but mean difference was not significant. The use of interposition graft significantly delayed time of nerve recovery, 6.24 vs 4.06 months (95% CI, 0.20 to 4.16). When controlled for main trunk coaptation only, interposition nerve graft delayed recovery but difference was no longer statistically significant, 6.24 vs 4.75 months (95% CI, -0.94 to 3.92). Reported complications were minor and rare occurring in only 6.5% (12 of 183) of patients. Conclusions and Relevance The masseteric nerve was found to be a good option for nerve transfer in this patient population, and showed favorable results in both time to nerve recovery and improvement in oral commissure excursion. Level of Evidence NA.
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Affiliation(s)
- Alexander W Murphey
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - William B Clinkscales
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Samuel L Oyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
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Effectiveness and safety of the use of gracilis muscle for dynamic smile restoration in facial paralysis: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2019; 72:1254-1264. [PMID: 31204152 DOI: 10.1016/j.bjps.2019.05.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/16/2019] [Accepted: 05/16/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Smiling is a fundamental component of social interactions. Significant challenges arise for patients with facial palsy. One of the key procedures for dynamic smile restoration is the microneurovascular transfer of a gracilis muscle. We aimed to assess the effectiveness and safety of dynamic smile reanimation surgery using the free gracilis muscle unit in patients with facial palsy. METHODS We conducted a systematic review and meta-analysis of studies reporting surgical outcomes of dynamic smile restoration using free gracilis muscles identified from EMBASE, Medline, and Web of Science databases from their inception to March 15, 2018. Two-stage screening and data extraction were performed by two independent reviewers. Pooled proportions were calculated using random-effects models. RESULTS Thirty-one studies including 1647 patients who underwent 1739 free gracilis flaps were included. Twelve (38.7%) studies measured perioperative smile excursion change using six different tools. Six of these studies were homogeneous and were used in meta-analyses of smile excursion improvement, which revealed a mean change of 7.5 mm (95% CI 6.0-9.0 mm, I2 86.7%) perioperatively. Twenty (64.5%) studies reported perioperative complications, and pooled proportions of flap failures were of 2.9% (95% CI 1.3-4.5%, I2 47.7%). CONCLUSIONS Dynamic smile restoration using a free gracilis muscle may represent an effective procedure to regain oral commissure motion and is associated with an approximately 3% rate of flap failure. Masseteric nerve coaptations lead to larger improvements in perioperative smile excursion (10 mm) than cross-facial nerve grafts (6.8 mm). Future studies with homogeneous reporting of smile excursion and patient-reported outcome measures are needed.
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Facial reanimation with masseter nerve-innervated free gracilis muscle transfer in established facial palsy patients. Arch Plast Surg 2019; 46:122-128. [PMID: 30934175 PMCID: PMC6446028 DOI: 10.5999/aps.2018.00717] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 02/07/2019] [Indexed: 11/08/2022] Open
Abstract
Background The masseter nerve is a useful donor nerve for reconstruction in patients with established facial palsy, with numerous advantages including low morbidity, a strong motor impulse, high reliability, and fast reinnervation. In this study, we assessed the results of masseter nerve–innervated free gracilis muscle transfer in established facial palsy patients. Methods Ten patients with facial palsy who received treatment from January 2015 to January 2017 were enrolled in this study. Three patients received masseter nerve–only free gracilis transfer, and seven received double-innervated free gracilis transfer (masseter nerve and a cross-face nerve graft). Patients were evaluated using the Facial Assessment by Computer Evaluation software (FACEgram) to quantify oral commissure excursion and symmetry at rest and when smiling after muscle transfer. Results The mean time between surgery and initial movement was roughly 167.7 days. A statistically significant increase in excursion at rest and when smiling was seen after muscle transfer. There was a significant increase in the distance of oral commissure excursion at rest and when smiling. A statistically significant increase was observed in symmetry when smiling. Terzis’ functional and aesthetic grading scores showed significant improvements postoperatively. Conclusions Masseter nerve innervation is a good option with many uses in in established facial palsy patients. For some conditions, it is the first-line treatment. Free gracilis muscle transfer using the masseter nerve has excellent results with good symmetry and an effective degree of recovery.
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Contralateral Botulinum Toxin Improved Functional Recovery after Tibial Nerve Repair in Rats. Plast Reconstr Surg 2019; 142:1511-1519. [PMID: 30188467 DOI: 10.1097/prs.0000000000004981] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is clinical and experimental evidence that botulinum toxin applied to the healthy side of patients with facial paralysis positively affects functional recovery of the paralyzed side. The authors created an experimental model to study the effects of botulinum toxin injection in the gastrocnemius muscle contralateral to the side of tibial nerve lesion/repair in rats. METHODS Fifty rats were allocated into five groups: group I, control; group II, tibial nerve section; group III, tibial nerve section and immediate neurorrhaphy; group IV, tibial nerve section, immediate neurorrhaphy, and botulinum toxin injected into the contralateral gastrocnemius muscle; and group V, botulinum toxin injected into the gastrocnemius muscle and no surgery. Assessment tools included a walking track, electromyography, gastrocnemius muscle weight measurement, and histologic analysis of the nerve. RESULTS Paralysis in group V was transient, with function returning to normal at 8 weeks. At 12 weeks, group V had lower latency levels. At week 12, group IV showed higher functional outcomes and amplitude levels than group III, and lower muscle atrophy on the side injected with botulinum toxin compared with group V. CONCLUSION Transient paralysis of the contralateral gastrocnemius muscle by botulinum toxin type A improved functional recovery in rats that underwent section and repair of the tibial nerve.
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Nepomuceno AC, de Faria JC, Politani EL, Silva EG, Salomone R, Longo MV, Lima W, Salles AG, Gemperli R. Convergent end-to-end neurorrhaphy: An alternative technique for dual innervation of the gastrocnemius muscle in rats. Microsurgery 2019; 39:535-542. [PMID: 30706529 DOI: 10.1002/micr.30433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 12/29/2018] [Accepted: 01/11/2019] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Muscle contraction generated by electrical impulses simultaneously originating from two different neural sources may be an interesting treatment alternative for long term facial palsy. An experimental model was designed to compare single and dual innervation of the gastrocnemius muscle (GM) in rats. METHODS Fifty adult Wistar rats underwent transection of their right peroneal nerve and were divided into five groups (n = 10): control (C), tibial nerve section (TS), tibial nerve primary end-to-end neurorrhaphy (PEE), tibial nerve primary repair associated with end-to-side peroneal-to-tibial nerve transfer (PRES), and tibial nerve repair by convergent end-to-end (CEE) neurorrhaphy between the proximal stumps of the tibial and peroneal nerves to the distal stump of the tibial nerve. The outcomes were assessed 12 weeks after the experiment by walking track, electromyography, GM mass index, and histomorphometric analysis of the distal tibial nerve. RESULTS The functional recovery of the PRES (-33.77 ± 24.13) and CEE (-42.15 ± 31.14) groups was greater (P < 0.003) than the PEE group (-80.26 ± 17.20). The CEE group (18.35 ± 7.84) showed greater amplitude (P = 0.006) than the PEE group (8.2 ± 4.64). There was no difference in the muscle mass index among the reinnervation groups (P > 0.705). Histologic analysis revealed greater (P < 0.002) axonal density in the CEE group (126.70 ± 15.01) compared to PEE (99.70 ± 12.82) and PRES (92.00 ± 19.17) groups. CONCLUSIONS The dual innervation techniques showed earlier and greater functional recovery of the GM than did the single innervation technique. The CEE group showed a 40% higher number of regenerated axons in the distal tibial nerve stump.
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Affiliation(s)
- André C Nepomuceno
- Plastic Surgery Department, Hospital das Clínicas, University of São Paulo, São Paulo, São Paulo, Brazil
| | - José C de Faria
- Plastic Surgery Department, Hospital das Clínicas, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Elisa L Politani
- Plastic Surgery Department, Hospital das Clínicas, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Eduardo G Silva
- Plastic Surgery Department, Hospital das Clínicas, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Raquel Salomone
- Plastic Surgery Department, Hospital das Clínicas, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Marco V Longo
- Plastic Surgery Department, Hospital das Clínicas, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Washington Lima
- Plastic Surgery Department, Hospital das Clínicas, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Alessandra G Salles
- Plastic Surgery Department, Hospital das Clínicas, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Rolf Gemperli
- Plastic Surgery Department, Hospital das Clínicas, University of São Paulo, São Paulo, São Paulo, Brazil
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Matsumine H, Kamei W, Fujii K, Shimizu M, Osada A, Sakurai H. One-stage reconstruction by dual-innervated double muscle flap transplantation with the neural interconnection between the ipsilateral masseter and contralateral facial nerve for reanimating established facial paralysis: A report of 2 cases. Microsurgery 2018; 39:457-462. [PMID: 30512222 DOI: 10.1002/micr.30397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 09/23/2018] [Accepted: 10/05/2018] [Indexed: 11/12/2022]
Abstract
The authors developed a one-stage double-muscle reconstruction technique for facial paralysis using a latissimus dorsi (LD) flap and a serratus anterior (SA) flap, which were dually reinnervated by the contralateral facial nerve (FN) and ipsilateral masseter nerve (MN). The procedure was performed for 61-year-old man 3-years after resection of a malignant tumor and a 24-year-old woman 10-years after temporal fracture with facial paralysis. A double-muscle flap comprising left LD and SA flaps was harvested, a 15-cm thoracodorsal nerve (TN) section was attached to the LD flap, and 5-cm and 1-cm sections of the long thoracic nerve (LTN) were attached to the proximal and distal sides of SA flap. The LD flap and SA flap were sutured along the direction of motion of the zygomaticus major and risorius muscles, respectively. The contralateral FN and ipsilateral MN were interconnected by nerve suturing: the medial branch of TN to the distal end of LTN, the proximal end of LTN to the ipsilateral MN, and the buccal branch of contralateral FN to the main trunk of TN. After surgery, good contraction of the transferred flaps resulted in reanimation of a natural symmetrical smile; no complications were observed during the 12-month follow-up period.
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Affiliation(s)
- Hajime Matsumine
- Department of Plastic and Reconstructive Surgery, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Wataru Kamei
- Department of Plastic and Reconstructive Surgery, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Kaori Fujii
- Department of Plastic and Reconstructive Surgery, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Mari Shimizu
- Department of Plastic and Reconstructive Surgery, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsuyoshi Osada
- Department of Plastic and Reconstructive Surgery, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Sakurai
- Department of Plastic and Reconstructive Surgery, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
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Cross-Face Nerve Grafting versus Masseteric-to-Facial Nerve Transposition for Reanimation of Incomplete Facial Paralysis. Plast Reconstr Surg 2018; 142:179e-191e. [DOI: 10.1097/prs.0000000000004612] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Amer TA, El Kholy MS. The split hypoglossal nerve versus the cross-face nerve graft to supply the free functional muscle transfer for facial reanimation: A comparative study. J Plast Reconstr Aesthet Surg 2018; 71:750-757. [DOI: 10.1016/j.bjps.2018.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 12/13/2017] [Accepted: 01/21/2018] [Indexed: 11/24/2022]
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Dong A, Zuo KJ, Papadopoulos-Nydam G, Olson JL, Wilkes GH, Rieger J. Functional outcomes assessment following free muscle transfer for dynamic reconstruction of facial paralysis: A literature review. J Craniomaxillofac Surg 2018; 46:875-882. [DOI: 10.1016/j.jcms.2018.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 02/20/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022] Open
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Bianchi B, Varazzani A, Pedrazzi G, Poddi V, Ferrari S, Brevi B, Ferri A. Masseteric cooptation and crossfacial nerve grafting: Is it still applicable 22 months after the onset of facial palsy? Microsurgery 2018; 38:860-866. [PMID: 29380892 DOI: 10.1002/micr.30296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/21/2017] [Accepted: 12/29/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Eighteen months is usually considered the cutoff time within which recovery of the mimic muscle remains possible using facial nerve cooptation. Few reports on the use of cooptation after this interval have appeared. Purpose of this study is to investigate the feasibility of this procedure also after 22 months. METHODS Six patients treated via crossfacial nerve grafting between healthy and paralyzed middle and middle-upper facial nerve branches and masseteric cooptation of the main trunk of the paralyzed facial nerve between 20 and 24 months after the onset of palsy were analyzed. Population consisted of two males and four females ages 8-42 years (mean 24 years). Facial palsy developed after acoustic neuroma resection in three patients, after the removal of a cerebellopontine angle astrocytoma in one, and as a consequence of Bell's palsy or cerebral hemorrhage in the other two (one each). House-Brackman and Sunnybrook clinical evaluation systems and FDI questionnaire were used to assess results. RESULTS House-Brackman scores changed from VI before the operation for all patients to II for two patients and III for four patients. Sunnybrook scores were 0-10 before the operation, but 62-84 at the last visit. Mean FDI scores moved from 24 to 38.5 meaning a statistical high significant improvement (P < .01). CONCLUSIONS Masseteric/crossfacial nerve grafting is feasible for patients with palsies 20-24 months in duration, affording satisfactory functional and esthetic results and a dramatic improvement in quality of life.
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Affiliation(s)
- B Bianchi
- Maxillo-Facial Surgery Division (Head: Professor Enrico Sesenna), Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - A Varazzani
- Maxillo-Facial Surgery Division (Head: Professor Enrico Sesenna), Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - G Pedrazzi
- Department of Neuroscience, University of Parma, Parma, Italy
| | - V Poddi
- Maxillo-Facial Surgery Division (Head: Professor Enrico Sesenna), Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - S Ferrari
- Maxillo-Facial Surgery Division (Head: Professor Enrico Sesenna), Head and Neck Department, University Hospital of Parma, Parma, Italy
| | - B Brevi
- Maxillo-Facial Surgery Division, University Hospital of Pisa, Pisa, Italy
| | - A Ferri
- Maxillo-Facial Surgery Division (Head: Professor Enrico Sesenna), Head and Neck Department, University Hospital of Parma, Parma, Italy
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Qualitative and Quantitative Analysis of Smile Excursion in Facial Reanimation: A Systematic Review and Meta-analysis of 1- versus 2-stage Procedures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1621. [PMID: 29632792 PMCID: PMC5889470 DOI: 10.1097/gox.0000000000001621] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/08/2017] [Indexed: 11/26/2022]
Abstract
Background: Free functional muscle transfer has become a common treatment modality for smile restoration in long-lasting facial paralysis, but the selection of surgical strategy between a 1-stage and a 2-stage procedure has remained a matter of debate. The aim of this study was to compare the quantitative and qualitative outcomes of smile excursion between 1-stage and 2-stage free muscle transfers in the literature. Methods: A comprehensive review of the published literature between 1975 and end of January 2017 was conducted. Results: The abstracts or titles of 2,743 articles were screened. A total of 24 articles met our inclusion criteria of performing a quantitative or qualitative evaluation of a free-functioning muscle transfer for smile restoration. For the purpose of meta-analysis, 7 articles providing quantitative data on a total of 254 patients were included. When comparing muscle excursion between 1-stage and 2-stage procedures, the average range of smile excursion was 11.5 mm versus 6.6 mm, respectively. For the purpose of systematic review, 17 articles were included. The result of the systematic review suggested a tendency toward superior functional results for the 1-stage procedure when comparing the quality of smile. Conclusions: The results of this review must be interpreted with great caution. Quantitative analysis suggests that 1-stage procedures produce better excursion than 2-stage procedures. Qualitative analysis suggests that 1-stage procedures might also produce superior results when based on excursion and symmetry alone, but these comparisons do not include one important variable dictating the quality of a smile—the spontaneity of the smile. The difficulty in comparing published results calls for a consensus classification system for facial palsy.
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Bianchi B, Ferri A, Poddi V, Bergonzani M, Pedrazzi G, Ferrari S, Sesenna E. Masseteric nerve for gracilis muscle re-innervation in unilateral facial palsy: Impact on quality of life. J Craniomaxillofac Surg 2017; 45:1051-1057. [DOI: 10.1016/j.jcms.2017.03.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 01/03/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022] Open
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Defining the Optimal Segment for Neurotization—Axonal Mapping of Masseter Nerve for Facial Reanimation. Ann Plast Surg 2016; 77:450-5. [DOI: 10.1097/sap.0000000000000743] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hontanilla B, Cabello A. Spontaneity of smile after facial paralysis rehabilitation when using a non-facial donor nerve. J Craniomaxillofac Surg 2016; 44:1305-9. [DOI: 10.1016/j.jcms.2016.06.031] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 05/24/2016] [Accepted: 06/29/2016] [Indexed: 10/21/2022] Open
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Bos R, Reddy SG, Mommaerts MY. Lengthening temporalis myoplasty versus free muscle transfer with the gracilis flap for long-standing facial paralysis: A systematic review of outcomes. J Craniomaxillofac Surg 2016; 44:940-51. [DOI: 10.1016/j.jcms.2016.05.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/10/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022] Open
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Facial animation with gracilis muscle transplant reinnervated via cross-face graft: Does it change patients' quality of life? J Craniomaxillofac Surg 2016; 44:934-9. [DOI: 10.1016/j.jcms.2016.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 04/07/2016] [Accepted: 05/09/2016] [Indexed: 11/18/2022] Open
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Biglioli F, Colombo V, Rabbiosi D, Tarabbia F, Giovanditto F, Lozza A, Cupello S, Mortini P. Masseteric-facial nerve neurorrhaphy: results of a case series. J Neurosurg 2016; 126:312-318. [PMID: 27035172 DOI: 10.3171/2015.12.jns14601] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Facial palsy is a well-known functional and esthetic problem that bothers most patients and affects their social relationships. When the time between the onset of paralysis and patient presentation is less than 18 months and the proximal stump of the injured facial nerve is not available, another nerve must be anastomosed to the facial nerve to reactivate its function. The masseteric nerve has recently gained popularity over the classic hypoglossus nerve as a new motor source because of its lower associated morbidity rate and the relative ease with which the patient can activate it. The aim of this work was to evaluate the effectiveness of masseteric-facial nerve neurorrhaphy for early facial reanimation. METHODS Thirty-four consecutive patients (21 females, 13 males) with early unilateral facial paralysis underwent masseteric-facial nerve neurorrhaphy in which an interpositional nerve graft of the great auricular or sural nerve was placed. The time between the onset of paralysis and surgery ranged from 2 to 18 months (mean 13.3 months). Electromyography revealed mimetic muscle fibrillations in all the patients. Before surgery, all patients had House-Brackmann Grade VI facial nerve dysfunction. Twelve months after the onset of postoperative facial nerve reactivation, each patient underwent a clinical examination using the modified House-Brackmann grading scale as a guide. RESULTS Overall, 91.2% of the patients experienced facial nerve function reactivation. Facial recovery began within 2-12 months (mean 6.3 months) with the restoration of facial symmetry at rest. According to the modified House-Brackmann grading scale, 5.9% of the patients had Grade I function, 61.8% Grade II, 20.6% Grade III, 2.9% Grade V, and 8.8% Grade VI. The morbidity rate was low; none of the patients could feel the loss of masseteric nerve function. There were only a few complications, including 1 case of postoperative bleeding (2.9%) and 2 local infections (5.9%), and a few patients complained about partial loss of sensitivity of the earlobe or a small area of the ankle and foot, depending on whether great auricular or sural nerves were harvested. CONCLUSIONS The surgical technique described here seems to be efficient for the early treatment of facial paralysis and results in very little morbidity.
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Affiliation(s)
| | | | | | | | | | - Alessandro Lozza
- Neurophysiopathology Service, C. Mondino National Neurological Institute, Pavia; and
| | | | - Pietro Mortini
- Department of Neurosurgery, San Raffaele Hospital, University Vita e Salute, Milan, Italy
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Biglioli F. Facial reanimations: part II—long-standing paralyses. Br J Oral Maxillofac Surg 2015; 53:907-12. [DOI: 10.1016/j.bjoms.2015.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/01/2015] [Indexed: 11/30/2022]
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Sforza C, Frigerio A, Mapelli A, Tarabbia F, Annoni I, Colombo V, Latiff M, Pimenta Ferreira CL, Rabbiosi D, Sidequersky FV, Zago M, Biglioli F. Double-powered free gracilis muscle transfer for smile reanimation: A longitudinal optoelectronic study. J Plast Reconstr Aesthet Surg 2015; 68:930-9. [DOI: 10.1016/j.bjps.2015.03.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 02/19/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
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Okazaki M, Kentaro T, Noriko U, Satoshi U, Tsutomu H, Alisa O, Mayuko H, Hiroki M. One-stage dual latissimus dorsi muscle flap transfer with a pair of vascular anastomoses and double nerve suturing for long-standing facial paralysis. J Plast Reconstr Aesthet Surg 2015; 68:e113-9. [DOI: 10.1016/j.bjps.2015.02.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 12/02/2014] [Accepted: 02/02/2015] [Indexed: 11/26/2022]
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Gordin E, Lee TS, Ducic Y, Arnaoutakis D. Facial nerve trauma: evaluation and considerations in management. Craniomaxillofac Trauma Reconstr 2015; 8:1-13. [PMID: 25709748 DOI: 10.1055/s-0034-1372522] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The management of facial paralysis continues to evolve. Understanding the facial nerve anatomy and the different methods of evaluating the degree of facial nerve injury are crucial for successful management. When the facial nerve is transected, direct coaptation leads to the best outcome, followed by interpositional nerve grafting. In cases where motor end plates are still intact but a primary repair or graft is not feasible, a nerve transfer should be employed. When complete muscle atrophy has occurred, regional muscle transfer or free flap reconstruction is an option. When dynamic reanimation cannot be undertaken, static procedures offer some benefit. Adjunctive tools such as botulinum toxin injection and biofeedback can be helpful. Several new treatment modalities lie on the horizon which hold potential to alter the current treatment algorithm.
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Affiliation(s)
- Eli Gordin
- Department of Otolaryngology-Head and Neck Surgery, SUNY Downstate Medical Center, Brooklyn, New York
| | - Thomas S Lee
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas ; Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Demetri Arnaoutakis
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Cardenas-Mejia A, Covarrubias-Ramirez JV, Bello-Margolis A, Rozen S. Double innervated free functional muscle transfer for facial reanimation. J Plast Surg Hand Surg 2014; 49:183-8. [PMID: 25469588 DOI: 10.3109/2000656x.2014.988218] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The treatment of long-standing facial palsy represents a challenge for the reconstructive surgeon. Treatment is based on dynamic procedures such as functional muscle flaps. The benefit of added axonal load has recently been reported. This study describes a two stage technique involving dual innervation of a gracilis muscle flap with initial cross-facial nerve graft (CFNG) followed by free muscle transfer co-apted to both the CFNG and a masseter nerve for facial reanimation. METHODS A total of nine patients from August 2008-July 2011 were operated on with the double innervated gracilis muscle flap. Pre- and postoperative electromyography was documented, and video analysis with the five-stage classification of reanimation outcomes was performed. RESULTS All patients recovered voluntary and spontaneous smile abilities, with an average of 70% motor unit recruitment. Based on the Terzis reanimation outcome classification, four patients had an excellent result, four good, and one moderate. CONCLUSIONS The double innervated gracilis muscle flap is a viable technique for the treatment of long-standing facial palsy. It enables a fast recovery with fast muscle activity, and allows an emotional smile and aesthetic symmetry.
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Affiliation(s)
- Alexander Cardenas-Mejia
- Division of Plastic and Reconstructive Surgery, Hospital General Dr. Manuel Gea Gonzalez , Mexico City , Mexico
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Kurita M, Yamazaki K, Eto H, Seike S, Takushima A, Harii K. Reinnervation of segmented latissimus dorsi muscle with the distal stump of the thoracodorsal nerve: A preliminary experimental study in rats. Microsurgery 2013; 33:545-50. [PMID: 24038515 DOI: 10.1002/micr.22164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 06/25/2013] [Accepted: 07/08/2013] [Indexed: 11/10/2022]
Abstract
To date, nerve stumps have been dissected at the proximal side of the donor muscle for reinnervation of the muscle in free neurovascular muscle transfer. Herein, we examined the use of the distal thoracodorsal nerve, dissected from the muscle belly at the distal side of the latissimus dorsi muscle, for the reinnervation of muscle. The rat right latissimus dorsi muscle was employed as the model for our study. Twenty Wistar rats were used in this study. A rectangular muscle segment was dissected with the distal stump of dominant thoracodorsal nerve. After rotation of muscle, the distal nerve stump was sutured to a severed proximal recipient thoracodorsal nerve (n = 5). The degree of reinnervation through the distal nerve stump was compared with control groups that received proximal-to-proximal nerve sutures (n = 5), nerves that were not severed (n = 5), and severed nerves that were not sutured (n = 5) using electrophysiological, histological, and muscular volume assessments. Reinnervation of the distal nerve stump was confirmed by the contraction of the muscle following electrical stimulation and electromyography. Crossing of axons into motor endplates was confirmed by histology. Results of these assays were similar to that of the proximal nerve suture group. The volume of muscle in the distal nerve suture group was not significant different from that of the proximal nerve suture group (P = 0.63). It was demonstrated that the distal stump of the thoracodorsal nerve can be used to innervate segmented latissimus dorsi muscle. This novel procedure for the reinnervation of transplanted muscle deserves further investigations.
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Affiliation(s)
- Masakazu Kurita
- Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan. masakazukurita@ aol.com
| | - Kazunori Yamazaki
- Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Hitomi Eto
- Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Shien Seike
- Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Akihiko Takushima
- Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Kiyonori Harii
- Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan
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Ginat DT, Bhama P, Cunnane ME, Hadlock TA. Facial reanimation procedures depicted on radiologic imaging. AJNR Am J Neuroradiol 2013; 35:1662-6. [PMID: 23945230 DOI: 10.3174/ajnr.a3684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Various facial reanimation procedures can be performed for treating patients with chronic facial nerve paralysis. The radiologic imaging features of static and dynamic techniques are reviewed in this article with clinical correlation, including brow lift, eyelid weights and springs, gracilis free flaps, fascia lata grafts, temporalis flaps, and Gore-Tex suspension slings. Although the anatomic alterations resulting from facial reanimation surgery may not necessarily be the focus of the imaging examination, it is important to recognize such changes and be familiar with MR imaging compatibility of the associated implanted materials. Furthermore, imaging is sometimes used to specifically evaluate the postoperative results, such as vessel patency following free gracilis transfer.
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Affiliation(s)
- D T Ginat
- From the Department of Radiology (D.T.G.), Division of Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts
| | - P Bhama
- Department of Otolaryngology (P.B., T.A.H.), Division of Facial Plastic and Reconstructive Surgery
| | - M E Cunnane
- Department of Radiology (M.E.C.), Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - T A Hadlock
- Department of Otolaryngology (P.B., T.A.H.), Division of Facial Plastic and Reconstructive Surgery
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Bianchi B, Ferri A, Ferrari S, Copelli C, Magri A, Ferri T, Sesenna E. Cross-facial nerve graft and masseteric nerve cooptation for one-stage facial reanimation: Principles, indications, and surgical procedure. Head Neck 2013; 36:235-40. [DOI: 10.1002/hed.23300] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Bernardo Bianchi
- Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Andrea Ferri
- Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Silvano Ferrari
- Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Chiara Copelli
- Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Alice Magri
- Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Teore Ferri
- Head and Neck Department; University Hospital of Parma; Parma Italy
| | - Enrico Sesenna
- Head and Neck Department; University Hospital of Parma; Parma Italy
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Facial Reanimation with Gracilis Muscle Transfer Neurotized to Cross-Facial Nerve Graft versus Masseteric Nerve. Plast Reconstr Surg 2013; 131:1241-1252. [DOI: 10.1097/prs.0b013e31828bd4da] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Biglioli F, Bayoudh W, Colombo V, Pedrazzoli M, Rabbiosi D. Double innervation (facial/masseter) sur le lambeau gracile dans les réanimations du tiers moyen de la face lors de la prise en charge des paralysies faciales : nouveau concept. ANN CHIR PLAST ESTH 2013; 58:89-95. [DOI: 10.1016/j.anplas.2012.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 12/10/2012] [Indexed: 11/24/2022]
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Kurita M, Takushima A, Shiraishi T, Kinoshita M, Ozaki M, Harii K. Recycle of temporal muscle in combination with free muscle transfer in the treatment of facial paralysis. J Plast Reconstr Aesthet Surg 2013; 66:991-5. [PMID: 23283482 DOI: 10.1016/j.bjps.2012.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 10/20/2012] [Accepted: 12/06/2012] [Indexed: 11/25/2022]
Abstract
We experienced three patients with long-standing unilateral complete facial paralysis who previously underwent temporalis muscle transfer to the cheek for smile reconstruction. All patients complained of insufficient and uncomfortable buccal motion synchronised with masticatory movements and incomplete eyelid closure with ptotic eyebrow. To attain a near-natural smile and reliable eyelid closure, temporalis muscle was displaced from the cheek to the eyelid, and a neurovascular free latissimus dorsi muscle was transferred for the replacement of cheek motion. As a result, cheek motion synchronised with the contralateral cheek upon smiling and sufficient eyelid closure were obtained in all cases. Smile reconstruction using the temporal muscle is an easy and a versatile way in general. However, spontaneous smile is not achieved and peculiar movement of the cheek while eating is conspicuous in some cases. Replacement with neurovascular free latissimus dorsi muscle and recycling previously used temporalis muscle for eyelid closure are considered to be valuable for such cases.
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Affiliation(s)
- Masakazu Kurita
- Department of Plastic Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan.
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Momeni A, Chang J, Khosla RK. Microsurgical reconstruction of the smile-contemporary trends. Microsurgery 2013; 33:69-76. [DOI: 10.1002/micr.22042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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The split hypoglossal nerve to supply the free functional muscle transfer in facial reanimation. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-012-0782-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Biglioli F, Colombo V, Tarabbia F, Autelitano L, Rabbiosi D, Colletti G, Giovanditto F, Battista V, Frigerio A. Recovery of Emotional Smiling Function in Free-Flap Facial Reanimation. J Oral Maxillofac Surg 2012; 70:2413-8. [DOI: 10.1016/j.joms.2011.11.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 11/24/2011] [Indexed: 11/16/2022]
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Militsakh ON, Sanderson JA, Lin D, Wax MK. Rehabilitation of a parotidectomy patient-A systematic approach. Head Neck 2012; 35:1349-61. [DOI: 10.1002/hed.23095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2012] [Indexed: 11/10/2022] Open
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Biglioli F, Colombo V, Tarabbia F, Pedrazzoli M, Battista V, Giovanditto F, Dalla Toffola E, Lozza A, Frigerio A. Double innervation in free-flap surgery for long-standing facial paralysis. J Plast Reconstr Aesthet Surg 2012; 65:1343-9. [PMID: 22728067 DOI: 10.1016/j.bjps.2012.04.030] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 04/21/2012] [Accepted: 04/26/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE One-stage free-flap facial reanimation may be accomplished by using a gracilis transfer innervated by the masseteric nerve, but this technique does not restore the patient's ability to smile spontaneously. By contrast, the transfer of the latissimus dorsi innervated by the contralateral facial nerve provides the correct nerve stimulus but is limited by variation in the quantity of contraction. The authors propose a new one-stage facial reanimation technique using dual innervation; a gracilis muscle flap is innervated by the masseteric nerve, and supplementary nerve input is provided by a cross-face sural nerve graft anastomosed to the contralateral facial nerve branch. METHODS Between October 2009 and March 2010, four patients affected by long-standing unilateral facial paralysis received gracilis muscle transfers innervated by both the masseteric nerve and the contralateral facial nerve. RESULTS All patients recovered voluntary and spontaneous smiling abilities. The recovery time to voluntary flap contraction was 3.8 months, and spontaneous flap contraction was achieved within 7.2 months after surgery. According to Terzis and Noah's five-stage classification of reanimation outcomes, two patients had excellent outcomes and two had good outcomes. CONCLUSIONS In this preliminary study, the devised double-innervation technique allows to achieve a good grade of flap contraction as well as emotional smiling ability. A wider number of operated patients are needed to confirm those initial findings.
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Affiliation(s)
- F Biglioli
- Department of Maxillo-Facial Surgery, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
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