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Shamil E, Tan DJY, Grobbelaar A. Outcomes of Free Flap Transfer in Facial Reanimation: A Review. Facial Plast Surg 2024. [PMID: 38336000 DOI: 10.1055/s-0044-1779628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
Abstract
Free functional muscle transfer is is an option for reanimating the face in chronic facial nerve paralysis. The optimal outcome in these patients is the ability to restore a spontaneous smile in response to emotion. We discuss the role of free functional muscle transfer in facial paralysis treatment, the choices of nerve used in reconstruction surgery, and the application of different types of muscle flaps in facial reanimation. In this paper, we review the relevant and up-to-date academic literature regarding the outcomes of free functional muscle flap transfer in facial paralysis patients.
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Affiliation(s)
- Eamon Shamil
- ENT Surgery Department, The Royal National ENT Hospital, University College London Hospital, London, United Kingdom
| | - Denise Jia Yun Tan
- ENT Surgery Department, Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire, United Kingdom
| | - Adriaan Grobbelaar
- Department of Plastic Surgeon, Great Ormond Street Hospital, London, United Kingdom
- Division of Surgery and Interventional Science, University College of London, London, United Kingdom
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Bern, Switzerland
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Lee KT, Lee SH, Mun GH. Comparison of Outcomes of Smile Reanimation Between Dual- Versus Single-Innervation Technique in Single-Stage Latissimus Dorsi Neuromuscular Transfer in Facial Paralysis Patients. Facial Plast Surg Aesthet Med 2023; 25:505-511. [PMID: 36749167 DOI: 10.1089/fpsam.2022.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background: Although a dual-innervation technique has emerged in single-stage functional latissimus dorsi (LD) muscle transfer for smile reanimation, its benefits over conventional techniques have not been elucidated. Objective: To compare outcomes of dual-innervation technique with those of single-innervation. Methods: Patients with facial palsy treated with single-stage functional LD muscle transfer were identified, and categorized into two groups: single and dual innervation. Outcomes were assessed using clinical examination based on the Terzis grading system and using automated software (Emotrics). Results: Fifty-nine patients (mean age 37.6 years; male/female 30/29) were analyzed, including 40 in single (35.1 years, 23/17) and 19 in dual-innervation group (43.0 years, 7/12), with a median follow-up of 34 months (range, 9-165) (single: 41.5, 12-165, dual: 23.0, 9-41). Tumor-related paralysis was the most common etiology in both groups (overall: 45.8%, single: 40.0%, dual: 57.9%). The dual group had a significantly higher rate of cases with Terzis grade IV or V postoperatively. In the Emotrics-based evaluation, the dual group exhibited significantly enhanced improvements in smile excursion in the dynamic state compared with the single. The degree of improvement in the resting state did not differ between groups. Conclusion: The dual-innervation technique might provide promising results in achieving enhanced smile excursion.
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Affiliation(s)
- Kyeong-Tae Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Hun Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Goo-Hyun Mun
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Deramo PJ, Seitz AJ, Shakir S, Greives MR, Low DW, Jackson OA, Nguyen PD. Dual-Innervated Free Gracilis Muscle Transfer for Facial Reanimation in Children. Ann Plast Surg 2022; 89:538-42. [PMID: 36279580 DOI: 10.1097/SAP.0000000000003287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Facial palsy may have deleterious effects for pediatric patients. The most common reconstruction is 2-stage free gracilis muscle transfer (FGMT) after cross-face nerve graft (CFNG). This requires a prolonged period from time of surgery to smile. New techniques using both a CFNG and motor nerve to masseter (MNM) as dual power sources in a single-stage surgery have been described in adults. Here, we examine our experience with this technique in children. METHODS A retrospective study was performed examining patients who underwent dual-innervated single-stage FGMT at 2 pediatric hospitals from 2016 to 2019. Demographics, etiology, perioperative characteristics, time to mandibular and emotional smile, and Sunnybrook scores were recorded. RESULTS Five patients met inclusion criteria with a mean age of 11.8 (range, 8-20). Two patients had congenital facial palsy while 3 had acquired facial palsy. Four patients (80%) received dual end-to-end neural coaptations of the CFNG and MNM to the obturator nerve. One (20%) had end-to-side coaptation of the CFNG to the obturator nerve and end-to-end of the MNM to the obturator nerve. The average time to mandibular smile was 103 ± 15.4 days. The average time to emotional smile was 245 ± 48.1 days. The preoperative Sunnybrook scale was 32 ± 7.5 and improved to 55.3 ± 20.6 at 8 months postoperatively. CONCLUSIONS Dual-innervated FGMT is effective for facial reanimation in children with unilateral facial palsy. Patients can harness a stronger motor source (MNM) and the component of an emotional stimulus (CFNG). This approach may be the new criterion standard pediatric facial reanimation.
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Ibarra G, Lasso JM. Salvage Procedures for Facial Reanimation With Neurovascular Flaps When Previous Surgeries Failed: Is Homolateral Vessel or Nerve Depletion a Contraindication? Ann Plast Surg 2022; Publish Ahead of Print. [DOI: 10.1097/sap.0000000000003061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Elbatawy AM, Hamdi A, Ouf MO, Zayid T, Ismail H, Sholkamy K, Hussin H, Elbanoby T, Ayad WM. Facial Reanimation With Free Latissumus Dorsi Muscle Transfer, a Comparative Study Between Lateral and Supine Approach. J Craniofac Surg 2021; 32:1118-21. [PMID: 32947333 DOI: 10.1097/SCS.0000000000007053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT In this article, the authors present the versatility of the Latissmus dorsi muscle as a donor option in facial reanimation and compare between different approaches in harvesting this muscle.The study included 24 Latissimus Dorsi (LD) functional muscles were transferred for smile reanimation of complete facial palsy. The patients were classified into 2 groups in which the muscle either harvested with supine or lateral (trans-axillary) approach. Muscle harvesting time, total operating times, blood loss, and bulkiness of the flap were analyzed and compared. The hypoglossal nerve was used in 14 cases, the masseteric nerve in 4 cases, and the lower trunk of the facial nerve was used in 6 cases as adonor nerve. No microvascular complications were observed, hematoma occurred in 2 cases only. No donor site complications in any of the cases.The trans-axillary approach provides less operative time, blood loss, and donor site morbidity, while the classic approach is easier and has the advantage of skin paddle in complex cases.
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Rodriguez Colon R, Park JJ, Boczar D, Diep GK, Berman ZP, Trilles J, Chaya BF, Rodriguez ED. Evaluating Functional Outcomes in Reanimation Surgery for Chronic Facial Paralysis: A Systematic Review. Plast Reconstr Surg Glob Open 2021; 9:e3492. [PMID: 33758730 DOI: 10.1097/GOX.0000000000003492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/26/2021] [Indexed: 11/26/2022]
Abstract
Background: Chronic facial paralysis can lead to significant functional and psychosocial impairment. Treatment often involves free muscle flap-based facial reanimation surgery. Although surgical techniques have advanced considerably over the years, consensus has yet to be reached for postoperative outcome evaluation. To facilitate outcome comparison between the various techniques for free muscle-flap-based reanimation, a standardized, widely accepted functional outcomes assessment tool must be adopted. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we performed a systematic review of the PubMed, Cochrane, and Embase databases to identify the reported functional outcome measurement tools used in the free muscle flap-based reanimation literature. Results: The search yielded 219 articles, 43 of which met our inclusion and exclusion criteria. We noted an increase in publications reporting the utilization of objective measures over time, particularly software-based tools, as well as increased utilization of patient reported outcomes measures. Conclusions: Based on the trends identified in the literature, we suggest standardization of outcome measures following facial reanimation surgery with free muscle-flap using a combination of the Facial Assessment by Computer Evaluation (FACEgram) software and the Facial Clinimetric Evaluation (FaCE) Scale.
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Watanabe Y, Yamamoto T, Hirai R, Sasaki R, Agawa K, Akizuki T. One-stage free transfer of latissimus dorsi-serratus anterior combined muscle flap with dual innervation for smile reanimation in established facial paralysis. J Plast Reconstr Aesthet Surg 2020; 73:1107-15. [DOI: 10.1016/j.bjps.2020.01.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 12/25/2019] [Accepted: 01/05/2020] [Indexed: 11/19/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Wang W, Kang S, Coto Hernández I, Jowett N. A Rapid Protocol for Intraoperative Assessment of Peripheral Nerve Myelinated Axon Count and Its Application to Cross-Facial Nerve Grafting. Plast Reconstr Surg 2019; 143:771-8. [PMID: 30601328 DOI: 10.1097/PRS.0000000000005338] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Donor nerve myelinated axon counts correlate with functional outcomes in reanimation procedures; however, there exists no reliable means for their intraoperative quantification. In this article, the authors report a novel protocol for rapid quantification of myelinated axons from frozen sections, and demonstrate its applicability to surgical practice. METHODS The impact of various fixation and FluoroMyelin Red staining strategies on resolved myelin sheath morphology from cryosections of rat and rabbit femoral and sciatic nerves was assessed. A protocol comprising fresh cryosection and rapid staining was developed, and histomorphometric results were compared against conventional osmium-postfixed, resin-embedded, toluidine blue-stained sections of rat sciatic nerve. The rapid protocol was applied for intraoperative quantification of donor nerve myelinated axon count in a cross-facial nerve grafting procedure. RESULTS Resolution of myelinated axon morphology suitable for counting was realized within 10 minutes of tissue harvest. Although mean myelinated axon diameter appeared larger using the rapid fresh-frozen as compared to conventional nerve processing techniques (mean ± SD; rapid, 9.25 ± 0.62 μm; conventional, 6.05 ± 0.71 μm; p < 0.001), no difference in axon counts was observed on high-power fields (rapid, 429.42 ± 49.32; conventional, 460.32 ± 69.96; p = 0.277). Whole nerve myelinated axon counts using the rapid protocol herein (8435.12 ± 1329.72) were similar to prior reports using conventional osmium processing of rat sciatic nerve. CONCLUSIONS A rapid protocol for quantification of myelinated axon counts from peripheral nerves using widely available equipment and techniques has been described, rendering possible intraoperative assessment of donor nerve suitability for reanimation.
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Lee KT, Lee YJ, Kim A, Mun GH. Evaluation of Donor Morbidity following Single-Stage Latissimus Dorsi Neuromuscular Transfer for Facial Reanimation. Plast Reconstr Surg 2019; 143:152e-64e. [PMID: 30325893 DOI: 10.1097/PRS.0000000000005168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Single-stage latissimus dorsi neuromuscular transfer has been a valuable option for dynamic smile reanimation. However, there is a paucity of studies evaluating the potential donor morbidity in such cases. The present study aimed to comprehensively analyze the donor morbidity following functional latissimus dorsi muscle transfer. METHODS Patients who underwent single-stage functional latissimus dorsi muscle transfer for smile reanimation between 2002 and 2016 were reviewed. Postoperative complications and functional impairments at the donor sites were evaluated. The Quick-Disabilities of the Arm, Shoulder and Hand questionnaire was used for assessing postoperative donor-site function. RESULTS Sixty patients, including 12 pediatric (18 years or younger) patients, were analyzed. Mean length of a harvested thoracodorsal nerve was 14.9 cm. Fourteen patients were treated with a dual innervation technique, in which both a descending and a transverse branch of the thoracodorsal nerve were harvested. Donor complications were observed in seven cases; all of them were seromas and resolved by simple aspiration. No other complications including scoliosis and sensory and/or motor disturbances in the upper extremities were encountered. Fifty patients responded to the Quick-Disabilities of the Arm, Shoulder and Hand questionnaire at a median follow-up of 51 months. The average score was 2.64, and all but three patients scored less than 10. No variables, including patient age (pediatric versus adult) and the use of a dual-innervation technique, affected the donor morbidities, including the functional deficits. CONCLUSION Single-stage latissimus dorsi neuromuscular transfer for facial reanimation might be associated with a low rate of complications and minimal functional morbidity at the donor site. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Abstract
PURPOSE OF REVIEW To review recent literature on the subject of free tissue transfer options in paediatric head and neck surgery, with a particular emphasis on highlighting the advantages and disadvantages of different reconstructions in the paediatric patient. RECENT FINDINGS Free tissue transfer in paediatric patients is predictable and applicable for a wide range of congenital and acquired defects in the head and neck. The free fibula flap is a mainstay of mandibular reconstruction and allows excellent implant-supported prosthodontic rehabilitation and growth potential at the recipient site with little or no donor site morbidity. Other less commonly explored options include the deep circumflex iliac artery flap, scapula flap and medial femoral condyle flap. The gracilis mucle remains the mainstay for facial reanimation with other options including pectoralis minor, rectus abdominis, extensor digitorum brevis and latissimus dorsi. There are compelling arguments for centralization of services and creative strategies in postoperative rehabilitation (e.g. play therapy). SUMMARY Free flaps in paediatric patients are a viable option and may even have advantages relative to adults because of the absence of atherosclerosis, purported lower risk of vasospasm and proportionally larger vessel size. Transfer earlier in life maximizes functional potential and 'normalizes' treatment.
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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] [What about the content of this article? (0)] [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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Hembd A, Harrison B, Rocha CSM, Rocha FS, Chamseddin K, Labbé D, Cárdenas-Mejía A, Rozen SM. Facial Reanimation in the Seventh and Eighth Decades of Life. Plast Reconstr Surg 2018; 141:1239-51. [PMID: 29697623 DOI: 10.1097/PRS.0000000000004329] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Treatment of facial paralysis in the older population is often relegated to static rather than dynamic reanimation for fear of poor outcomes. This pervasive approach lacks physiologic foundation and is not evidence based. Thus, the authors present an extensive literature review demonstrating weak evidence supporting this misguided concept, followed by detailed outcomes from three centers of the largest reported series to date of patients older than 60 years after reanimation performed using three techniques-lengthening temporalis myoplasty, free functional muscle, and nerve transfers. METHODS A PubMed search spanning over 40 years identified all reports on reanimation in patients older than 60 years. In addition, detailed demographics, surgical techniques, and outcomes of 30 patients older than 60 years were analyzed. RESULTS Of 629 articles, only 45 patients were identified, described in case reports or small series, lacking details or consistent long-term follow-up. In the clinical series, average age, preoperative House-Brackmann score, and comorbidities were similar among the groups. Highest excursion was observed in the free functional muscle group, followed by nerve transfer and temporalis myoplasty, averaging 10.4, 6.8, and 3.1 mm, respectively. The most notable philtral deviation correction was in the lengthening temporalis myoplasty group, followed by the free muscle and nerve transfer groups, averaging 5.6, 2.2, and 1.13 mm, respectively. Complication rates were highest in the free functional muscle group. CONCLUSIONS Facial palsy patients should not be denied dynamic restoration based on age alone. Although surgical technique may vary based on duration of palsy, surgeon experience, and preference, with each presenting advantages and disadvantages, dynamic restoration is feasible regardless of age. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Uehara M, Shimizu F. The Distal Stump of the Intramuscular Motor Branch of the Obturator Nerve Is Useful for the Reconstruction of Long-Standing Facial Paralysis Using a Double-Powered Free Gracilis Muscle Flap Transfer. J Craniofac Surg 2018; 29:476-81. [DOI: 10.1097/scs.0000000000004064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Faris C, Heiser A, Hadlock T, Jowett N. Free gracilis muscle transfer for smile reanimation after treatment for advanced parotid malignancy. Head Neck 2017; 40:561-568. [DOI: 10.1002/hed.25022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/11/2017] [Accepted: 10/10/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
- Callum Faris
- Department of Facial Plastic Reconstructive Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
| | - Alyssa Heiser
- Department of Facial Plastic Reconstructive Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
| | - Tessa Hadlock
- Department of Facial Plastic Reconstructive Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
| | - Nate Jowett
- Department of Facial Plastic Reconstructive Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
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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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Scaglioni MF, Verdini F, Marchesini A, Neuendorf AD, Coccia D, Leo T, Riccio M. Assessment of functional outcomes of temporalis muscle transfers for patients with longstanding facial paralysis. Head Neck 2016; 38 Suppl 1:E1535-43. [PMID: 26752232 DOI: 10.1002/hed.24275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 07/09/2015] [Accepted: 09/13/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Usually, clinical evaluation of facial reanimation provides accurate information about contraction of the mimetic muscles and phonation but fails to identify smile recovery and to quantify the motility of the lower third of the face during a smile. The purpose of this study was to verify that, in longstanding facial palsy, the modified temporalis muscle transfer (MTMT) can result in the ability to smile, not only voluntarily with chewing, but also spontaneously with a sudden emotional stimulus, and to confirm that a symmetric smile can be obtained. METHODS Ten patients of the treated group (group T; 4 women and 6 men) were randomly selected from a population of 24 patients with longstanding facial palsy treated by MTMT. Five normal subjects of the control group (group C; 3 women and 2 men) were enrolled as the control population. Functional outcomes after transposed temporalis muscle were examined and measured through clinical assessment by using a scored smile symmetry grading system, video recording, and surface electromyography (sEMG). In addition, the voluntary smile test (VST) and the not-voluntary smile test (NVST) were performed to study voluntary and spontaneous smiling. RESULTS Subjects in the VST group (group T) were able to smile voluntarily and the expression was characterized by symmetry. In the NVST group, they were able to smile spontaneously and the symmetry of the smile was maintained for 8 subjects and only partially for 2 subjects. During both tests, the temporalis muscle of the treated side and the orbicularis oris muscle of the not-treated side were activated during smiling, indicating spontaneous activity of the transposed temporalis muscle with an emotional stimulus. For the control group, smiles during VST and NVST were symmetric and the temporalis muscles were not activated during smiling, whereas the orbicularis oris muscles were. CONCLUSION Our study shows that the Morrison MTMT is able to restore the voluntary smile ability. Particularly, this technique allows for recovery of the spontaneous smile with symmetry. This assessment would seem to suggest that the transposed temporalis muscle might adapt from a chewing to a mimetic muscle. © 2016 Wiley Periodicals, Inc. Head Neck 38: E1535-E1543, 2016.
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Affiliation(s)
- Mario F Scaglioni
- Department of Reconstructive Surgery and Hand Surgery, AUO Ospedali Riuniti di Ancona, Univerista' Politecnica delle Marche, Ancona, Italy
| | - Federica Verdini
- Department of Informatics Engineering, Universita' Politecnica delle Marche, Ancona, Italy
| | - Andrea Marchesini
- Department of Reconstructive Surgery and Hand Surgery, AUO Ospedali Riuniti di Ancona, Univerista' Politecnica delle Marche, Ancona, Italy
| | - Alexander Dietrich Neuendorf
- Department of Reconstructive Surgery and Hand Surgery, AUO Ospedali Riuniti di Ancona, Univerista' Politecnica delle Marche, Ancona, Italy
| | - Daniele Coccia
- Department of Informatics Engineering, Universita' Politecnica delle Marche, Ancona, Italy
| | - Tommaso Leo
- Department of Informatics Engineering, Universita' Politecnica delle Marche, Ancona, Italy
| | - Michele Riccio
- Department of Reconstructive Surgery and Hand Surgery, AUO Ospedali Riuniti di Ancona, Univerista' Politecnica delle Marche, Ancona, Italy
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Glass GE, Mosahebi A, Shakib K. Cross-specialty developments: a summary of the mutually relevant recent literature from the journal of plastic, reconstructive and aesthetic surgery. Br J Oral Maxillofac Surg 2015; 54:13-21. [PMID: 26628201 DOI: 10.1016/j.bjoms.2015.08.272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 08/26/2015] [Indexed: 12/18/2022]
Abstract
Keeping abreast of current developments is increasingly challenging when the volume of specialty articles being published is rising exponentially, and it is most acute when surgical specialties overlap, as in the case of head, neck, and facial reconstructive surgery. Here, the potential for missing key developments presents a compelling case for a summary article that highlights articles likely to be of mutual relevance. We evaluated 129 original studies and 6 reviews published in the Journal of Plastic, Reconstructive, and Aesthetic Surgery between September 2012 and August 2014, and summarised the main papers of interest and merit under the subheadings of head and neck reconstruction, cleft lip and palate, craniomaxillofacial surgery, facial palsy, facial trauma, and aesthetic surgery. Most of the evidence presented (86%) is level 4.
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Affiliation(s)
- Graeme E Glass
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Kennedy Institute of Rheumatology, Roosevelt Drive, Oxford, OX 3 7FY.
| | - Ash Mosahebi
- Royal Free Hospital NHS Foundation trust, Pond Street, Hampstead, London, NW3 2QG
| | - Kaveh Shakib
- Royal Free Hospital NHS Foundation trust, Pond Street, Hampstead, London, NW3 2QG
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Okochi M, Ueda K, Okochi H, Asai E, Sakaba T, Kajikawa A. Facial reanimation using hypoglossal-facial neurorrhaphy with end-to-side coaptation between the jump interpositional nerve graft and hypoglossal nerve: Outcome and duration of preoperative paralysis. Microsurgery 2015; 36:460-6. [DOI: 10.1002/micr.22393] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 02/06/2015] [Accepted: 02/13/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Masayuki Okochi
- Department of Plastic and Reconstructive Surgery; Fukushima Medical University; Fukushima City Fukushima 960-1295 Japan
| | - Kazuki Ueda
- Department of Plastic and Reconstructive Surgery; Fukushima Medical University; Fukushima City Fukushima 960-1295 Japan
| | - Hiromi Okochi
- Department of Plastic and Reconstructive Surgery; Fukushima Medical University; Fukushima City Fukushima 960-1295 Japan
| | - Emiko Asai
- Department of Plastic and Reconstructive Surgery; Fukushima Medical University; Fukushima City Fukushima 960-1295 Japan
| | - Takao Sakaba
- Department of Plastic and Reconstructive Surgery; Fukushima Medical University; Fukushima City Fukushima 960-1295 Japan
| | - Akiyoshi Kajikawa
- Department of Plastic and Reconstructive Surgery; Fukushima Medical University; Fukushima City Fukushima 960-1295 Japan
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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] [What about the content of this article? (0)] [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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22
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Veyssière A, Labbé D, Bénateau H. Lengthening temporalis myoplasty and facial paralysis from birth. J Plast Reconstr Aesthet Surg 2015; 68:312-20. [DOI: 10.1016/j.bjps.2014.10.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 10/21/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
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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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24
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Watanabe Y, Sasaki R, Agawa K, Akizuki T. Bidirectional/double fascia grafting for simple and semi-dynamic reconstruction of lower lip deformity in facial paralysis. J Plast Reconstr Aesthet Surg 2015; 68:321-8. [PMID: 25434708 DOI: 10.1016/j.bjps.2014.10.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/31/2014] [Accepted: 10/31/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND For the total aesthetic reconstruction of facial paralysis, treatment of lower lip deformity as "a neglected target in facial reanimation" is important. Although various dynamic reconstruction approaches have been reported for lower lip deformity, these have not been popularly performed due to aggressive surgical invasiveness, long recovery time for reinnervation, and unstable outcomes. To reconstruct the lower lip deformity more simply but semi-dynamically, we modified bidirectional/double fascia grafting methods that have been established as simple and minimally invasive treatments for pediatric congenital lower lip paralysis. METHODS Between 2009 and 2011, nine patients were treated using this procedure alone or with combinations of other procedures of facial reanimation such as one-stage free muscle transfer. For outcome assessment, patients were evaluated using a lower lip paralysis grading system, including the objective aesthetics and functional results of the lower lip at rest (score range, 0-1), during smiling (score range, 0-4), and during mouth opening (score range, 0-2). RESULTS The mean total scores improved from 1.43 (poor) preoperatively to 5.71 (excellent) postoperatively. In all evaluation items, the postoperative scores improved significantly compared to the preoperative scores (p<0.01) with no severe complications. CONCLUSIONS The procedure is simply applied to various types of extensive facial paralysis, as well as congenital lower lip paralysis in combination with other static and dynamic reconstruction methods for facial paralysis, and it is suggested that this approach significantly and semi-dynamically improves the aesthetic function of the lower lip at rest, during smiling, and during mouth opening.
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Leckenby J, Grobbelaar A. Smile restoration for permanent facial paralysis. Arch Plast Surg 2013; 40:633-8. [PMID: 24086823 DOI: 10.5999/aps.2013.40.5.633] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 03/14/2013] [Accepted: 03/15/2013] [Indexed: 11/08/2022] Open
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26
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Shimizu Y, Suzuki S, Mori-Yoshimura M, Nagasao T, Toriumi M, Oji T, Murata M, Kishi K. Surgical treatment of severe blepharoptosis and facial palsy caused by oculopharyngodistal myopathy. J Plast Reconstr Aesthet Surg 2013; 66:e277-80. [PMID: 23602269 DOI: 10.1016/j.bjps.2013.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 03/15/2013] [Accepted: 03/16/2013] [Indexed: 11/25/2022]
Abstract
Oculopharyngodistal myopathy is an extremely rare disease characterised by slowly progressive blepharoptosis, facial and bulbar muscle weakness and distal leg myopathy. We report the case of a 72-year-old woman with severe bilateral blepharoptosis and facial palsy caused by oculopharyngodistal myopathy that was present for more than 29 years. The condition was successfully treated by simple surgical intervention.
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Affiliation(s)
- Yusuke Shimizu
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo 160-8582, Japan.
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