Neurotized Platysma Graft: A New Technique for Functional Reanimation of the Eye Sphincter in Longstanding Facial Paralysis

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.

Lower Eyelid Management in Facial Paralysis

“…Nassif and Yung Chia recently characterized initial results of blink reanimation via cross-facial nerve grafting paired with second-stage direct neurotization of free nonvascularized platysma grafts secured across the lower and upper eyelids. 33 Multivector free vascularized functional muscle flaps also carry potential for simultaneous reanimation of dynamic smile and blink function in patients with facial palsy. 34,35 Fig.…”

Clinical Efficacy, Healing Efficacy, and Safety Analysis of Skin Orbicularis Oculi Muscle Combined with Tissue Flap for Eyelid Trauma

“…In the past, conventional blepharoplasty and repair surgery are mostly achieved by arbitrary flap transfer, and the specific step is to select a flap around the patient's eyelid according to the location of eyelid injury and cover the damaged area [ 9 ]. However, studies have shown that after traditional conventional surgery, patients do not get a good prognosis and are prone to other complications, such as appearance scar, lack of overall aesthetic feeling, and skin pigmentation, which seriously affect the appearance aesthetics and clinical satisfaction of patients [ 10 ]. In addition, eyelid skin defect is also prone to corneal injury, which is mainly because eyelid injury leads to the loss of effective corneal protection, and patients' eyes are at increased risk of external stimulation and bacterial damage.…”

Cross Facial Nerve Grafting for Smile Restoration: Thoughts on Improving Graft Inset

“…[1][2][3][4][5] They may be used for targeting different mimetic muscles in varied facial subunits, such as the periorbita, midface, and lower lip, [6][7][8][9][10] in both the acute and subacute settings, complementing "babysitter" strategies, or for innervating free functional muscle transfers (FFMTs) and even grafts in long-standing paralysis. [11][12][13][14] Traditionally, CFNG is transferred to the contralateral face through the upper lip in a subcutaneous, submucosal, [15][16][17] or periosteal tunnel 12,18 and banked directly in front of the preauricular incision in a straight line, usually tagged and tacked in place with a large identifiable permanent suture. CFNG can be used in single-and two-stage facial reanimation procedures.…”