Successful salvage surgery after treatment failures with cross graft and free muscle transplant in facial reanimation

Abstract Background The microneurovascular transfer of a free-muscle transplant is the procedure of choice for facial animation, It is characterized by low morbidity in both adult and paediatric patients. In spite of the improvements in microsurgical techniques, failures due to absent revascularizat...

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Bibliographic Details
Published in:Journal of cranio-maxillo-facial surgery 2012-02, Vol.40 (2), p.185-189
Main Authors: Bianchi, B, Copelli, C, Ferrari, S, Ferri, A, Sesenna, E
Format: Article
Language:English
Subjects:
Carotid Artery, External
Child
Dentistry
Face - blood supply
Facial Expression
Facial Nerve - transplantation
Facial Paralysis - congenital
Facial Paralysis - surgery
Failure of facial animation
Free Tissue Flaps - blood supply
Free Tissue Flaps - innervation
Gracilis free transplant
Graft Rejection
Humans
Jugular Veins
Magnetic Resonance Angiography
Male
Masseter Muscle - innervation
Microsurgery - methods
Muscle, Skeletal - blood supply
Muscle, Skeletal - innervation
Muscle, Skeletal - transplantation
Nerve Transfer - methods
Reconstructive Surgical Procedures
Reoperation
Salvage surgery
Salvage Therapy
Surgery
Thigh - surgery
Treatment Outcome
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Summary:Abstract Background The microneurovascular transfer of a free-muscle transplant is the procedure of choice for facial animation, It is characterized by low morbidity in both adult and paediatric patients. In spite of the improvements in microsurgical techniques, failures due to absent revascularization or reinnervation of the transplanted muscle or infections causing flap necrosis are observed. We propose a second surgical procedure based on the gracilis muscle transplant reinnervated by the masseteric nerve as a solution for these cases. Methods We analyzed and report on two patients treated in our department after the failure of a previous cross-facial nerve graft and free muscle transplant. They were treated with a new facial reanimation using the contralateral gracilis muscle and the masseteric nerve as the donor nerve. Results and discussion We did not observe any postoperative complications, and all of the flaps survived. Reinnervation and contraction of the muscle appeared 3–4 months postoperatively, with good functional and aesthetic results. Conclusions This technique is a one-step procedure characterized by reliable flap harvesting, low donor site morbidity and good activity of the masseteric nerve. We consider it as a good option for treatment of facial animation failures.
ISSN:1010-5182
1878-4119
DOI:10.1016/j.jcms.2011.03.016