Muscle transplantation for reconstruction of a smile after facial paralysis past, present, and future

Abstract

Reconstruction of a natural, spontaneous, symmetrical smile remains the ultimate goal of reanimation of the mid-face after facial paralysis. Recently the one-stage mini-gracilis muscle transplantation, innervated by the contralateral facial nerve, has been introduced to solve this difficult problem. This paper illustrates by means of a historical review the numerous procedures which have led to the development of this intervention. Moreover, it addresses relevant differences between the classical two-stage procedure using a cross-facial nerve graft and the recently advocated one-stage procedure. The underlying neurophysiological mechanism and determination of the final functional outcome of the neurovascular muscle transfer to the face are discussed, and areas which deserve future research are mentioned.

Involuntary Movement during Mastication in Patients with Long-Term Facial Paralysis Reanimated with a Partial Gracilis Free Neuromuscular Flap Innervated by the Masseteric Nerve

“…1 In the senior author's (S.R.) opinion, use of the facial nerve for innervation of the transferred muscle, whether via a crossfacial nerve graft in a two-stage procedure or via a long, vascularized nerve pedicle in a one-stage procedure to the contralateral facial nerve, [2][3][4] frequently produces superior results, namely by producing a spontaneous and emotional smile. Still, there are certain indications for use of other donor nerves.…”

Subdivision of the sural nerve: Step towards individual facial reanimation

“…The goal of spontaneous and involuntary mimic activity on the paralysed side of the face, however, could only be achieved by using the facial nerve [3,9,10]. Even by using the VII nerve as a crossfacial nerve graft from the other side, the input nearly always reaches the entire transplanted muscle through one single neurovascular bundle of the muscle transplant, resulting mainly in a mass action of the muscle.…”

Free Functional Gracilis Muscle Transplantation for Reconstruction of Active Elbow Flexion in Posttraumatic Brachial Plexus Lesions

“…Stehen nach der Nervenkoaptation noch zusätzliche Faszikel zur Reinnervation zur Verfügung, können diese durch Implantation in den Muskel im Sinne einer direkten neuromuskulären Reinnervation im Bereich des motorischen Felds des Muskels für ein noch günstigeres Reinnervationsergebnis genutzt werden [20]. [21]. Zur Minimierung der Ischämiezeit bleibt das Transplantat so lange an seinem Gefäß-Nerven-Stiel mit dem Spendergebiet verbunden, bis alle Strukturen im Empfängergebiet zuverlässig dargestellt sind.…”