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.
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.
Authors: Benjamin Kasukonis; John Kim; Lemuel Brown; Jake Jones; Shahryar Ahmadi; Tyrone Washington; Jeffrey Wolchok Journal: Tissue Eng Part A Date: 2016-09-23 Impact factor: 3.845
Authors: Joseph R Dusseldorp; Martinus M van Veen; Diego L Guarin; Olivia Quatela; Nate Jowett; Tessa A Hadlock Journal: JAMA Facial Plast Surg Date: 2019-12-01 Impact factor: 4.611
Authors: Alessio Baccarani; Marta Starnoni; Giovanna Zaccaria; Alexandre Anesi; Elisa Benanti; Antonio Spaggiari; Giorgio De Santis Journal: Plast Reconstr Surg Glob Open Date: 2019-06-19