Sterno-omohyoid Free Flap for Dual-Vector Dynamic Facial Reanimation

Abstract

Background: Dynamic rehabilitation of longstanding facial palsy with damaged, atrophied, or absent facial muscles requires replacement of neural and muscular components. The ideal reconstruction would include a fast-twitch muscle that is small, a reliable donor vessel and nerve, and the potential to provide a natural, synchronous, dentate smile with minimal donor site morbidity. Many flaps have been successfully used historically, but none has produced ideal rehabilitation. Objective: To evaluate the novel sterno-omohyoid, dual-vector flap in rehabilitation of chronic facial paralysis. Results: We performed sterno-omohyoid free tissue transfer for smile reanimation in a 39-year-old male with a history of longstanding right facial palsy following resection of a skull base tumor several years previously. We transferred both muscles with the superior thyroid artery, middle thyroid vein, and ansa cervicalis. The patient developed a dynamic smile by 6 months postoperatively, and he had improved objective facial symmetry. Conclusion: Herein, we demonstrate the first use of the sterno-omohyoid flap for successful facial reanimation. Overall, it is a novel flap in facial reanimation with many advantages over traditional flaps, including the potential to produce a more synchronous, dynamic smile while adding minimal bulk to the face. Future series will better elucidate the potential of the sterno-omohyoid flap.

Advances and future directions in the care of patients with facial paralysis

“…Alam et al 47 first reported the use of a novel sternohyoid muscle free flap using the ansa cervicalis for nerve coaptation and the superior thyroid artery as its vascular pedicle in a series of 24 fresh cadaver flap harvest procedures. Vincent et al 48 later described a dual vector transfer technique using the sternohyoid and omo-hyoid muscles together in cadaveric studies and report good outcomes with one patient who successfully underwent a dual-vector sterno-omohyoid flap with the superior thyroid artery, middle thyroid vein, and ansa cervicalis innervated by the nerve to masseter. Alegret et al 49 reported a sternohyoid flap innervated by the hypoglossal nerve in a single case.…”