Oral sphincter reanimation in longstanding flaccid facial paralysis by neurotized platysma muscle graft: A new technique.

Abstract

The gold standard treatment for longstanding facial paralysis is the microsurgical muscle flap transplant neurotized by crossface nerve graft. However, this technique is only applied for oral commissure excursion to restore the smile. The degenerated orbicularis oris muscle has never been replaced with another muscle to restore important mouth functions such as eating, drinking, and speech. The authors present a new surgical technique of neurotized avascular platysma muscle graft for oral sphincter reanimation in 2 surgical stages and evaluate the recovery of contraction of the grafted muscle, and restoration of mouth functions. Ten consecutive patients with flaccid longstanding facial paralysis were evaluated. Surgical technique: 2 branches that innervate the upper and lower lips were selected at the non-paralyzed side and coapted with 2 grafted crossface sural nerves bridging the paralyzed side. After axonal growth, 2 strips of avascular platysma muscle were grafted on the upper and lower lips, and neuromuscular neurotization was performed. The functional recovery was evaluated by the degree of muscle contraction, quantified in percentages and classified as Excellent (76% to 100%), Good (51% to 75%), Satisfactory (26% to 50%), and Fair (0% to 25%). Quality-of-life was measured using the Facial Disability Index. Functional recovery was Excellent, Good, Satisfactory, and Fair in 50%, 10%, 30%, and 10% of patients, respectively, and 59.4% of improvement in quality-of-life. The neuromuscular neurotization of small muscle grafts is feasible and an efficient way to achieve functional recovery of the oral sphincter in flaccid longstanding facial paralysis. LEVEL OF EVIDENCE: Therapeutic, IV.