Anterior belly of digastric muscle transfer: A useful technique in head and neck surgery (original) (raw)
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Archives of Plastic Surgery, 2015
Background Botulinum toxin (BT) chemodenervation and anterior belly of digastric muscle (ABD) transfer are both treatment options in the management of an isolated marginal mandibular branch of the facial nerve (MMB) palsy. We compare the patient satisfaction following either BT injections or ABD transfer in the management of their isolated MMB palsy. Methods Patients in the ABD-arm of the study were identified retrospectively from September 2007 to July 2014. The patients in the BT-arm of the study were identified prospectively from those attending the clinic. Both groups of patients completed a validated patient satisfaction survey. Statistical analysis was performed and a P-value < 0.05 was considered statistically significant. Results Seven patients were in the ABD-arm and 11 patients in the BT-arm of the study. The patient satisfaction in both groups was high with 45% of ABD-arm patients and 40% of BTarm patients rating their overall outcome as 'better' or 'much better', which was significantly more than the proportion rating their outcome as 'worse' or 'much worse' (P < 0.001), although there was a significant trend towards those in the ABD-arm being more likely to be dissatisfied with their outcome (P = 0.01). Conclusions BT therapy is a good first-line intervention in the management of isolated MMB palsy. We have, however, shown that the overall satisfaction in both groups is high. Therefore, in patients who would prefer a more permanent solution to manage their facial asymmetry, ABD transfer remains a satisfactory treatment option with a good level of patient satisfaction.
Masseteric-facial nerve coaptation – an alternative technique for facial nerve reinnervation
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2009
Background: Reinnervation of the facial musculature when there is loss of the proximal facial nerve poses a difficult clinical problem. Restoration of spontaneous mimetic motion is the aim and, to this end, the use of cross-facial nerve grafts has long been considered the reconstruction of choice. The nerve to masseter has been used very successfully for reinnervation of microvascular functioning muscle transfers for facial reanimation in established facial palsy but its use as a direct nerve transfer to the facial nerve to reinnervate 'viable' facial musculature has been scarce. Methods: Electron micrographic studies of axonal counts in the nerve to masseter and nerve to gracilis in a clinical series of seven patients undergoing surgery for facial nerve palsy were made. Based on these results, and previous success with the use of the nerve to masseter for reinnervation of free gracilis transfers, we report our experience with the transfer of the nerve to masseter for direct coaptation with the ipsilateral facial nerve to restore facial motion. Results: Our axonal counts of the nerve to masseter have, on average, 1542 AE 291.70 (SD) axons. Historical data have shown that the buccal branch of the facial nerve has 834 AE 285 (SD) where the distal end of a cross-facial nerve graft has 100 to 200 axons. Our clinical use of the nerve to masseter as a direct nerve transfer in three patients based on these data has resulted in significant improvement in facial symmetry in repose (at a minimum of 1 year follow up), restoration of facial motion with occasional spontaneous activity and minimal synkinesis without any donor morbidity. Conclusions: The advantages of this technique include the ease of dissection, constant and reliable anatomy, powerful reinnervation of the facial muscles without donor site morbidity and the potential for return of spontaneous facial movement.
Modern concepts in facial nerve reconstruction
2010
Background: Reconstructive surgery of the facial nerve is not daily routine for most head and neck surgeons. The published experience on strategies to ensure optimal functional results for the patients are based on small case series with a large variety of surgical techniques. On this background it is worthwhile to develop a standardized approach for diagnosis and treatment of patients asking for facial rehabilitation. Conclusion: A standardized approach is feasible: Patients with chronic facial palsy first need an exact classification of the palsy's aetiology. A step-by-step clinical examination, if necessary MRI imaging and electromyographic examination allow a classification of the palsy's aetiology as well as the determination of the severity of the palsy and the functional deficits. Considering the patient's desire, age and life expectancy, an individual surgical concept is applicable using three main approaches: a) early extratemporal reconstruction, b) early reconstruction of proximal lesions if extratemporal reconstruction is not possible, c) late reconstruction or in cases of congenital palsy. Twelve to 24 months after the last step of surgical reconstruction a standardized evaluation of the therapeutic results is recommended to evaluate the necessity for adjuvant surgical procedures or other adjuvant procedures, e.g. botulinum toxin application. Up to now controlled trials on the value of physiotherapy and other adjuvant measures are missing to give recommendation for optimal application of adjuvant therapies.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2014
Please cite this article as: Sforza C, Tarabbia F, Mapelli A, Colombo V, Sidequersky FV, Rabbiosi D, Annoni I, Biglioli F, Facial reanimation with masseteric to facial nerve transfer: a three-dimensional longitudinal quantitative evaluation.
Surgical and Radiologic Anatomy - SURG RADIOL ANATOMY, 1997
On account of the complex anatomy at the base of skull, surgery here may result in post operative cranial n. deficits. Facial palsy is often feared and its effects upon the patient’s psychological and emotional well-being can be catastrophic. The modest results and the side effects of the facio-hypoglossal anastomosis used for facial rehabilitation have led us to consider an anastomosis between a motor branch of the trigeminal n. and the facial n. Dissection has allowed us to demonstrate that the masseteric n. offers the characteristics and the relationships which should make such an anastomosis feasible.
New trends in management of facial nerve paralysis
Facial paralysis is an unsatisfactory pathology to treat, and the results of neural reconstruction are unsatisfactory. Fortunately spontaneous recovery is common. We will talk about the new trends in the management of Facial nerve Paralysis, which not include its Diagnosis but also its Treatment in this article which we hope to be useful for patients and of course for E.N.T. Doctors or any Doctors concern with this subject. The aim of this study will be focused on new trends in diagnosis and treatment of lower motor facial nerve Paralysis. The primary use of gracilis free tissue transfer in the head and neck region is in the form of a muscular free flap for the dynamic rehabilitation of long-standing permanent facial paralysis. When combined with cross-facial nerve grafting or used as a single-stage reconstruction, free tissue transfer offers the best prospect for restoring spontaneous emotional facial expression. Benefits of this muscle over other free flaps used for dynamic facial reanimation include consistent anatomy with large caliber vessels, ease of harvest, a 2-team approach, reliability, and acceptable donor site morbidity. Drawbacks include excessive bulk, skin tethering, and a donor site scar that may be minimized with minimally invasive techniques. Secondary procedures to refine the results are often necessary to achieve a good final result. Ultimately, the choice of muscle for dynamic facial reanimation depends on the surgeon's experience and comfort level.
The pedicled masseter transfer for facial nerve palsy reconstruction—an anatomical study
European Journal of Plastic Surgery, 2020
Background Dynamic facial reanimation is one of the key treatment goals for lower facial palsy patients. Currently, temporalis myoplasty is the only non-free flap muscle transfer option considered feasible with good outcome. Although masseter transfer has been attempted, it was associated with poor results or considered to be technically challenging. This cadaveric study aimed to re-evaluate the feasibility of masseter transfer by looking at its geometry and offer a new approach to the muscle. Methods Twenty-four masseter muscles were dissected in 12 fresh frozen cadavers through a preauricular rhytidectomy incision and a pre-parotid approach. The muscle's insertion and origin attachments were divided to allow for rotation toward the modiolus. The angle of rotation, vector of pull, transfer distance, and length of the muscle were measured. Results The mean angle of rotation was 40.1 degrees, and the mean vector of pull was 66.7 degrees. The mean transfer distance from the muscle's origin and insertion attachments was 30 and 62.5 mm, respectively. The mean lengths of the muscle's anterior, posterior, superior, and inferior borders were 55.3 mm, 46.3 mm, 42.6 mm, and 42 mm, respectively. Conclusions The distance, angle of transposition, and vector of pull measurements support the feasibility of pedicled masseter transfer in achieving optimal contraction vector with less risk of pedicle injury in lower facial palsy reconstruction. Tendon and fascial grafts can be adjuncts in cases where the masseter muscle length is short. The pre-parotid approach to the pedicled masseter transfer allows for a shorter operative time, which is desirable, particularly in the infirm. Level of evidence: Not ratable .
Facial Paralysis after Trauma: A Simplified Method to Find and Repair the Facial Nerve
Otolaryngology, 2018
This study aims to identify the digastric nerve as an alternative to access the facial nerve in case of post-traumatic facial nerve paralysis. Study design Retrospective study. Setting Tertiary care hospital. Subjects and Methods Eleven peripheric facial paralysis cases between 2005-2016 following trauma to the parotid gland are presented. Initial emergency treatments were done elsewhere but all returned back to treat facial paralysis after 11-18 months to our institute. The digastric nerve was identified and a facial-hypoglossal nerve anastomosis was performed. Results Pre-operative House-Brackmann scores were 6 for all cases. Post-operative scores were between 3 and 4. Pre-operative needle electromyography revealed no motor unit action potentials; after 7 months post-operatively, we had motor unit action potentials in every case. Conclusion In cases of trauma and secondary approaches of the parotid gland, a safe step for finding the facial nerve is to find the digastric nerve and follow it through the main trunk.
Dynamic Reconstruction for Facial Nerve Paralysis
Journal of Pharmaceutical Research International
Dynamic and static reconstruction procedures are employed for facial reanimation in patients suffering from facial nerve paralysis. Denervation and paralysis of the facial nerves causes considerable psychological and functional damage. Facial paralysis can affect facial expressiveness, communication, smile symmetry, eye protection, and speech competence. Due to their presumed poor prognosis, patients requiring facial nerve repair in a head and neck cancer practice are historically the least likely to receive a nerve graft. Dynamic reconstruction, on the other hand, is the gold standard in neurotology since patients are unlikely to die from their underlying condition. Even with malignant pathology, extended preoperative palsy, proximal nerve injury location, radiation, or long graft length, the current series supports the use of dynamic reconstruction. Dynamic facial reconstruction should be preformed in most cases unless there’s health risk of the method.