Double innervated free functional muscle transfer for facial reanimation

Alexander Cardenas-Mejia, Jorge Vladimir Covarrubias-Ramirez, Andres Bello-Margolis, Shai Rozen

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: The treatment of long-standing facial palsy represents a challenge for the reconstructive surgeon. Treatment is based on dynamic procedures such as functional muscle flaps. The benefit of added axonal load has recently been reported. This study describes a two stage technique involving dual innervation of a gracilis muscle flap with initial cross-facial nerve graft (CFNG) followed by free muscle transfer co-apted to both the CFNG and a masseter nerve for facial reanimation. Methods: A total of nine patients from August 2008-July 2011 were operated on with the double innervated gracilis muscle flap. Pre- and postoperative electromyography was documented, and video analysis with the five-stage classification of reanimation outcomes was performed. Results: All patients recovered voluntary and spontaneous smile abilities, with an average of 70% motor unit recruitment. Based on the Terzis reanimation outcome classification, four patients had an excellent result, four good, and one moderate. Conclusions: The double innervated gracilis muscle flap is a viable technique for the treatment of long-standing facial palsy. It enables a fast recovery with fast muscle activity, and allows an emotional smile and aesthetic symmetry.

Original languageEnglish (US)
Pages (from-to)183-188
Number of pages6
JournalJournal of Plastic Surgery and Hand Surgery
Volume49
Issue number3
DOIs
StatePublished - Jun 1 2014

Fingerprint

Facial Muscles
Facial Nerve
Facial Paralysis
Muscles
Neurophysiological Recruitment
Transplants
Aptitude
Electromyography
Esthetics
Therapeutics
Gracilis Muscle

Keywords

  • Babysitter
  • Facial palsy
  • Facial reanimation
  • Gracilis muscle flap

ASJC Scopus subject areas

  • Surgery

Cite this

Double innervated free functional muscle transfer for facial reanimation. / Cardenas-Mejia, Alexander; Covarrubias-Ramirez, Jorge Vladimir; Bello-Margolis, Andres; Rozen, Shai.

In: Journal of Plastic Surgery and Hand Surgery, Vol. 49, No. 3, 01.06.2014, p. 183-188.

Research output: Contribution to journalArticle

Cardenas-Mejia, Alexander ; Covarrubias-Ramirez, Jorge Vladimir ; Bello-Margolis, Andres ; Rozen, Shai. / Double innervated free functional muscle transfer for facial reanimation. In: Journal of Plastic Surgery and Hand Surgery. 2014 ; Vol. 49, No. 3. pp. 183-188.
@article{6506a344fd104e3e888e0f62c2c49eae,
title = "Double innervated free functional muscle transfer for facial reanimation",
abstract = "Background: The treatment of long-standing facial palsy represents a challenge for the reconstructive surgeon. Treatment is based on dynamic procedures such as functional muscle flaps. The benefit of added axonal load has recently been reported. This study describes a two stage technique involving dual innervation of a gracilis muscle flap with initial cross-facial nerve graft (CFNG) followed by free muscle transfer co-apted to both the CFNG and a masseter nerve for facial reanimation. Methods: A total of nine patients from August 2008-July 2011 were operated on with the double innervated gracilis muscle flap. Pre- and postoperative electromyography was documented, and video analysis with the five-stage classification of reanimation outcomes was performed. Results: All patients recovered voluntary and spontaneous smile abilities, with an average of 70{\%} motor unit recruitment. Based on the Terzis reanimation outcome classification, four patients had an excellent result, four good, and one moderate. Conclusions: The double innervated gracilis muscle flap is a viable technique for the treatment of long-standing facial palsy. It enables a fast recovery with fast muscle activity, and allows an emotional smile and aesthetic symmetry.",
keywords = "Babysitter, Facial palsy, Facial reanimation, Gracilis muscle flap",
author = "Alexander Cardenas-Mejia and Covarrubias-Ramirez, {Jorge Vladimir} and Andres Bello-Margolis and Shai Rozen",
year = "2014",
month = "6",
day = "1",
doi = "10.3109/2000656X.2014.988218",
language = "English (US)",
volume = "49",
pages = "183--188",
journal = "Journal of Plastic Surgery and Hand Surgery",
issn = "2000-656X",
publisher = "Informa Healthcare",
number = "3",

}

TY - JOUR

T1 - Double innervated free functional muscle transfer for facial reanimation

AU - Cardenas-Mejia, Alexander

AU - Covarrubias-Ramirez, Jorge Vladimir

AU - Bello-Margolis, Andres

AU - Rozen, Shai

PY - 2014/6/1

Y1 - 2014/6/1

N2 - Background: The treatment of long-standing facial palsy represents a challenge for the reconstructive surgeon. Treatment is based on dynamic procedures such as functional muscle flaps. The benefit of added axonal load has recently been reported. This study describes a two stage technique involving dual innervation of a gracilis muscle flap with initial cross-facial nerve graft (CFNG) followed by free muscle transfer co-apted to both the CFNG and a masseter nerve for facial reanimation. Methods: A total of nine patients from August 2008-July 2011 were operated on with the double innervated gracilis muscle flap. Pre- and postoperative electromyography was documented, and video analysis with the five-stage classification of reanimation outcomes was performed. Results: All patients recovered voluntary and spontaneous smile abilities, with an average of 70% motor unit recruitment. Based on the Terzis reanimation outcome classification, four patients had an excellent result, four good, and one moderate. Conclusions: The double innervated gracilis muscle flap is a viable technique for the treatment of long-standing facial palsy. It enables a fast recovery with fast muscle activity, and allows an emotional smile and aesthetic symmetry.

AB - Background: The treatment of long-standing facial palsy represents a challenge for the reconstructive surgeon. Treatment is based on dynamic procedures such as functional muscle flaps. The benefit of added axonal load has recently been reported. This study describes a two stage technique involving dual innervation of a gracilis muscle flap with initial cross-facial nerve graft (CFNG) followed by free muscle transfer co-apted to both the CFNG and a masseter nerve for facial reanimation. Methods: A total of nine patients from August 2008-July 2011 were operated on with the double innervated gracilis muscle flap. Pre- and postoperative electromyography was documented, and video analysis with the five-stage classification of reanimation outcomes was performed. Results: All patients recovered voluntary and spontaneous smile abilities, with an average of 70% motor unit recruitment. Based on the Terzis reanimation outcome classification, four patients had an excellent result, four good, and one moderate. Conclusions: The double innervated gracilis muscle flap is a viable technique for the treatment of long-standing facial palsy. It enables a fast recovery with fast muscle activity, and allows an emotional smile and aesthetic symmetry.

KW - Babysitter

KW - Facial palsy

KW - Facial reanimation

KW - Gracilis muscle flap

UR - http://www.scopus.com/inward/record.url?scp=84929331001&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84929331001&partnerID=8YFLogxK

U2 - 10.3109/2000656X.2014.988218

DO - 10.3109/2000656X.2014.988218

M3 - Article

C2 - 25469588

AN - SCOPUS:84929331001

VL - 49

SP - 183

EP - 188

JO - Journal of Plastic Surgery and Hand Surgery

JF - Journal of Plastic Surgery and Hand Surgery

SN - 2000-656X

IS - 3

ER -