Tomaz Nassif1, Chang Yung Chia. 1. Rio de Janeiro, Brazil From the Department of Reconstructive Microsurgery, HSE; and the Clínica de Cirurgia Plástica Rio de Janeiro.
Abstract
BACKGROUND: In 1984, Terzis reported on the potential use of a free platysma muscle transfer to reanimate the orbicularis oculi in longstanding paralysis of this unit. However, the vascularized platysma flap proved difficult to transfer, and this technique is not widely used today. In the present study, the authors have described the technique involving grafting of the platysma muscle to restore eyelid function and retrospectively discussed its clinical outcomes. METHODS: This retrospective analysis included patients with longstanding facial paralysis who underwent orbicularis oculi reconstruction with neurotized platysma grafts. The authors have described the surgical technique and its retrospective clinical outcomes. RESULTS: Between 1992 and 2015, 38 consecutive patients underwent this procedure; of them, 34 [16 men (47 percent) and 18 women (53 percent)] completed the follow-up. The time between the first and second surgical stages was a mean 8.6 months (range, 6 to 22 months). The surgical results were good in 18 patients (53 percent) and the recovery was satisfactory in 13 (38 percent). CONCLUSIONS: This study confirmed the feasibility and effectiveness of grafted muscle functional recovery and the efficiency of neuromuscular neurotization. The presented surgical technique is safe and effective for treating longstanding facial palsy of the orbicularis oculi muscle. This is the only technique that is easy and reproducible, leads to facial nerve recovery, and places a similar muscle at the original site of the paralyzed muscle for functional recovery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
BACKGROUND: In 1984, Terzis reported on the potential use of a free platysma muscle transfer to reanimate the orbicularis oculi in longstanding paralysis of this unit. However, the vascularized platysma flap proved difficult to transfer, and this technique is not widely used today. In the present study, the authors have described the technique involving grafting of the platysma muscle to restore eyelid function and retrospectively discussed its clinical outcomes. METHODS: This retrospective analysis included patients with longstanding facial paralysis who underwent orbicularis oculi reconstruction with neurotized platysma grafts. The authors have described the surgical technique and its retrospective clinical outcomes. RESULTS: Between 1992 and 2015, 38 consecutive patients underwent this procedure; of them, 34 [16 men (47 percent) and 18 women (53 percent)] completed the follow-up. The time between the first and second surgical stages was a mean 8.6 months (range, 6 to 22 months). The surgical results were good in 18 patients (53 percent) and the recovery was satisfactory in 13 (38 percent). CONCLUSIONS: This study confirmed the feasibility and effectiveness of grafted muscle functional recovery and the efficiency of neuromuscular neurotization. The presented surgical technique is safe and effective for treating longstanding facial palsy of the orbicularis oculi muscle. This is the only technique that is easy and reproducible, leads to facial nerve recovery, and places a similar muscle at the original site of the paralyzed muscle for functional recovery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.