Free vascularized double muscle transplantation for the treatment of facial paralysis.

Two cases of free neurovascular double muscle transplantation for facial paralysis are reported, with detailed descriptions of the operative technique and follow-up study. The latissimus dorsi muscle segment is placed between the nasolabial fold and the zygoma to substitute for the zygomatic and levator labii muscles, while the serratus anterior muscle segment is placed between the lower lip and the mandibular margin to substitute for the depressor labii muscles. The thoracodorsal nerve is sutured to the stump of the cross-face nerve graft, and the lateral thoracic nerve is sutured to a part of the hypoglossal nerve. The procedure is able to restore a relatively symmetrical smile, especially in patients with a full denture smile. The satisfactory results of this procedure are expected to lead to new prospects in the treatment of facial paralysis.