Simultaneous Surgical Treatment for Smile Dysfunction and Lagophthalmos Involving a Dual Latissimus Dorsi Flap

Abstract

Summary:Paralytic lagophthalmos and smile dysfunction are serious complications of facial paralysis and various reconstructive procedures have been developed to treat them. Among these procedures, there is no doubt that dynamic procedures are more effective than static ones. The 1-stage simultaneous surgical treatment of these 2 dysfunctions with a dynamic procedure involving a single muscle would be ideal, but no such methods have been reported. In this article, we present a 1-stage method for the simultaneous surgical treatment involving the use of a dual latissimus dorsi muscle flap. In this method, 2 muscle flaps based on the descending and transverse branches of the thoracodorsal vessels are transferred to the face. The descending and transverse branches of the thoracodorsal nerve are sutured to separate branches of the masseteric nerve. Using this method, complete eyelid closure during strong clenching and voluntary smiling during weak clenching without eyelid closure were achieved. Although our method does not result in spontaneous smiling, we believe that it is a good option for some patients with long-standing facial paralysis.

Chimeric Latissimus Dorsi Flap in One-Stage Reconstruction of Depressor Muscle Dysfunction and Depression Deformity in the Perimandibular Area

“…We often use LD flaps for secondary reconstruction after head and neck surgery 19–11,13 . They are versatile and can augment extensive depression and smile reanimation because they can be divided into components with a single vascular pedicle by branching of the thoracodorsal vessel and nerves.…”

“…We previously performed smile reanimation using free latissimus dorsi (LD) muscle or musculo-adiposal flaps. [9][10][11] Herein, we report its application in 3 cases of simultaneous reconstruction of DMs and depression deformity at the Tokyo Medical and Dental University Hospital. Suturing of the thoracodorsal nerve to the buccal branch of the ipsilateral facial nerve could provide satisfactory results.…”

“…We previously performed smile reanimation using free latissimus dorsi (LD) muscle or musculo-adiposal flaps 9–11 . Herein, we report its application in 3 cases of simultaneous reconstruction of DMs and depression deformity at the Tokyo Medical and Dental University Hospital.…”