Summary
Background
The pedicled masseter muscle transfer (PMMT) is introduced as a new reconstructive
option for dynamic smile restoration in patients with facial paralysis. The masseter
muscle is detached from both its origin and insertion and transferred to a new position
to imitate the function of the native zygomaticus major muscle.
Methods
Part one of this study consisted of cadaveric dissections of 4 heads (eight sides)
in order to determine whether the masseter muscle could be (a) pedicled solely by
its dominant neurovascular bundle and (b) repositioned directly over the native zygomaticus
major. The second part of the study consisted of clinical assessments in three patients
in order to confirm the applicability of this muscle transfer. Commissure excursion
and vector of contraction following PMMT were compared to the non-paralyzed side.
Results
In all eight sides, the masseter muscles were successfully isolated on their pedicle
and transposed on top of and in-line with the ipsilateral zygomaticus major. The mean
length of the masseter and its angle from Frankfurt's horizontal line after transposition
compared favorably to the native zygomaticus major muscle. In the clinical cases,
the mean commissure movements of the paralyzed and normal sides were 7 mm and 12 mm
respectively. The mean angles of commissural movement for the paralyzed and normal
sides were 62° and 59° respectively.
Conclusions
The PMMT can be used as a dynamic reconstruction for patients with permanent facial
paralysis. As we gain experience with the PMMT, it may be possible to use it as a
first-line option for patients not eligible for free micro-neurovascular reconstruction.
Keywords
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Article info
Publication history
Published online: April 04, 2012
Accepted:
March 8,
2012
Received:
November 14,
2011
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
