Muscle Bow Traction Method for Dynamic Facial Reanimation

SummaryLarge full-thickness oral defects involving the oral commissure continue to be a challenge for reconstructive surgeons.Although local flaps are the best option for full-thickness lip reconstruction, they are unavailable for large defects. In particular, recent advances in microsurgery have extended the available surgical options using free flaps, but for full-thickness large oral defects involving the oral commissure, it is still difficult to obtain good function and competence. The major disadvantages are the drooping and loosening of the reconstructed lip and the difficulty in restoring a natural oral commissure.We present 2 cases of lip reconstruction for full-thickness large defects involving the oral commissure in which free flaps with the muscle bow traction method were used to overcome these problems.In case 1, the lip was reconstructed with a free radial forearm-palmaris longus tendon composite flap. The tendon was sutured onto the orbicularis oris stumps.In case 2, the lip was reconstructed with a free anterolateral thigh flap including the fascia lata. A fascial strip in the flap was sutured to the residual orbicularis muscles. In each case, additional nonvascularized fascia lata was harvested 3 and suspended the reconstructed lip in transverse direction as a muscle bow traction method. Both patients achieved good oral competence without medial deviation of the oral commissure and were able to resume a regular diet without drooping and loosening of the reconstructed lip.For large full-thickness oral defects involving the oral commissure, transverse fascial suspension with muscle bow traction is useful for functional and cosmetic reconstruction.

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“…1 This may be attributable to the stiffness in the soft tissue caused by the wide subcutaneus scar formation and the radiation therapy.…”

Section: Discussionmentioning

confidence: 99%

Transverse fascial suspension with muscle bow traction: Advantages for full-thickness lip reconstruction involving the oral commissure using free flap

Sasaki¹,

Adachi²,

Sekido³

2012

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…Alternatively, the sling may be passed around the masseter muscle to achieve some degree of dynamic reanimation. 64 Experience with nonautogenous 65 materials has been less favourable.…”

Section: Suspension Proceduresmentioning

confidence: 99%

Ophthalmic management of facial nerve palsy

Lee

Currie

Collin

2004

Eye

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The ophthalmologist plays a pivotal role in the evaluation and rehabilitation of patients with facial nerve palsy. It is crucial to recognize and treat the potentially life-threatening underlying causes. The immediate ophthalmic priority is to ensure adequate corneal protection. The medium to long-term management consists of treatment of epiphora, hyperkinetic disorders secondary to aberrant regeneration and poor cosmesis. Patients should be appropriately referred for general facial re-animation. This review aims to provide a guide to the management of this complex condition.

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“…The gracillus, latissimus dorsi, and pectoralis minor muscles have been used. [5][6][7][8] However, these techniques are lengthy, require intricate microsurgical skill, and are associated with increased morbidity and longer hospital stay. 9 With hypoglossal-facial nerve grafting, difficulties can specifically occur in swallowing, speech, and mastication.…”

Section: Commentmentioning

confidence: 99%

“…10 Regional muscle transfer using temporalis and masseter muscles has also been described. 6,7,[11][12][13] Yet, even regional flaps require general anesthesia and extended operative time and hospitalization.…”

Section: Commentmentioning

confidence: 99%