37104 Double Powered Free Gracilis Muscle Transfer for Long Standing Facial Palsy

Saturday, September 29, 2018: 9:05 AM
Fumiaki Shimizu, MD, PhD , plastic surgery, Oita University hospital, Oita, Japan
Miyuki Uehara, Md , plastic surgery, Oita University hospital, Oita, Japan

Background: Double innervation of the transferred muscle with the contralateral facial nerve plus the ipsilateral masseteric nerve has been recently reported by some authors.z@From 2010, the double innervated free gracilis muscle transfer for long standing facial palsy patient has been performed in our department. The aim of this study was to assess the utility of our procedure of double innervation of free gracilis muscle for reconstruction of long-standing facial palsy.
Patients and methods: In our department, twelve cases of long-standing facial paralysis (eight cases of complete palsy and four cases of incomplete palsy) were reconstructed using a free gracilis muscle innervated with the masseteric and contralateral facial nerves. In our procedure, the intramuscular motor branch which was the distal stump of obturator nerve of the transferred muscle was identified and sutured to the ipsilateral masseteric nerve in an end-to-end fashion, and the obturator nerve of the transferred muscle was sutured to the cross-face nerve graft, which was coaptated with the contralateral facial nerve by end-to-end suturing ( Figure). At first, this operation was performed in one staged operation, but these days, the procedure was done in two staged operation in our department. In six cases, the procedure was performed in one staged procedure, and in another six cases, the procedure was performed in tow staged procedure.
Results: All patients in were followed up for more than 18 months and recovered their smiling function. The voluntary movement of the transferred muscle with teeth clenching was observed at about 4.7 months and 5.2 months after the operation in one staged group and two staged group respectively. The movement combined with contralateral mouth angle elevation was observed at about 9.5 months and 6.2 months after the operation in one staged group and two staged group respectively. All patient could elevate their mouth angle same as healthy side. The period that the transferred muscle started to move with CFNG was shorter in two staged group than in one staged group.
Conclusion: Our result showed that the advantage of our procedure was that both strong movement with clenching and spontaneous movement combined with healthy side could be archived. Two staged procedure seemed to be better than that of one staged procedure. However, the mechanism of double innervations is still unknown. Further study is necessary to elucidate the utility and indication of this procedure.