One-stage dual latissimus dorsi muscle transfer for flaccid facial paralysis in patients aged over 70 years.

Abstract

Dynamic reanimations are often declined for older patients with long-standing flaccid facial paralysis, despite limited evidence that advanced age alone predicts poor outcomes. We aimed to evaluate the outcomes of one-stage dual latissimus dorsi muscle transfer (LDMT) in patients aged ≥70 years. This two-centre retrospective series (January 2010-October 2022) included 8 patients aged ≥70 years with complete, long-standing flaccid facial paralysis who underwent one-stage free dual LDMT. The branches of the thoracodorsal nerve were coapted to the contralateral facial nerve (CLFN) and/or ipsilateral masseteric nerve (ILMN) according to three predefined patterns. The primary outcomes included the time to initial contraction of the CLFN- and ILMN-innervated segments (muscles A and B), Terzis grade and perioperative complications. The mean follow-up period was 55 months (range, 16-165 months). All flaps survived, and no perioperative haematoma, seroma or infection occurred. Initial contraction was detected at 4.3 months (range, 3-6 months) in ILMN-innervated muscle B and at 8.0 months (range, 6-12 months) in CLFN-innervated muscle A. Seven of 8 patients achieved Terzis grade 5, whereas one achieved grade 4. Six patients with dual-innervated LDMT demonstrated voluntary smiling via the ILMN and spontaneous smiling via the CLFN. In carefully selected patients aged ≥70 years, one-stage dual LDMT provided reliable smile restoration with excursion and spontaneity, while maintaining a low perioperative complication rate. Therefore, this technique is a safe and effective approach for dynamic reanimation in older patients, restoring smile function and improving quality of life.