Summary
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.
Keywords
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Article info
Publication history
Published online: June 25, 2012
Accepted:
April 26,
2012
Received:
October 2,
2011
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
