Introduction: The facial paralysis is a non-rare condition that has very disabling functional, morphological and psychological repercussions. The current gold standard in facial reanimation is revascularized re-innervated muscle transfers. Materials and methods: In this paper, we report the results of a new method using the gracilis flap with a double innervation on the masseter motor nerve and the controlateral facial nerve via a sural graft in a single stage intervention, on a series of six patients. Results: No failure was observed. The average delay of a voluntary contraction was 3.8. months, and 7.2. months for a spontaneous one. Three of the six patients had "excellent" results according to the Terzis and Noah classification, two were classified as "good" and one "average" Discussion: A choice is to be made between a method advocating a natural and spontaneous dynamicity (controlateral facial nerve stimulus) and a method focusing on the quality and quantity of contractions (ipsilateral trijeminal stimulus). In this new technique, we combine the two methods: a free gracilis transfer with a dual innervation on the healthy controlateral facial nerve via a sural graft, on one hand, and a second anastomosis on the ipsilateral masseter nerve, on the other hand. Conclusion: This new proposed method seems to be, according to our results, a reliable technique rallying voluntary contraction and emotional smile.

Double innervation (facial/masseter) on the gracilis flap, in the middle face reanimation in the management of facial paralysis: a new concept

Rabbiosi D
2013-01-01

Abstract

Introduction: The facial paralysis is a non-rare condition that has very disabling functional, morphological and psychological repercussions. The current gold standard in facial reanimation is revascularized re-innervated muscle transfers. Materials and methods: In this paper, we report the results of a new method using the gracilis flap with a double innervation on the masseter motor nerve and the controlateral facial nerve via a sural graft in a single stage intervention, on a series of six patients. Results: No failure was observed. The average delay of a voluntary contraction was 3.8. months, and 7.2. months for a spontaneous one. Three of the six patients had "excellent" results according to the Terzis and Noah classification, two were classified as "good" and one "average" Discussion: A choice is to be made between a method advocating a natural and spontaneous dynamicity (controlateral facial nerve stimulus) and a method focusing on the quality and quantity of contractions (ipsilateral trijeminal stimulus). In this new technique, we combine the two methods: a free gracilis transfer with a dual innervation on the healthy controlateral facial nerve via a sural graft, on one hand, and a second anastomosis on the ipsilateral masseter nerve, on the other hand. Conclusion: This new proposed method seems to be, according to our results, a reliable technique rallying voluntary contraction and emotional smile.
2013
2013
Dual innervation; Facial paralysis; Gracilis flap
Biglioli, F; Bayoudh, W; Colombo, V; Pedrazzoli, M; Rabbiosi, D
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11383/2118811
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