A Double‐Muscle Transfer using a Divided Rectus Femoris Muscle for Facial‐Paralysis Reconstruction

Abstract

There are two types of smiling: without exposure of the teeth (usual smile), and with their exposure (square smile). Performance of the former involves use of the major zygomatic muscle, while the latter is created by the major zygomatic and the depressor labii inferior muscles. The function of the depressor labii inferioris muscle cannot be ignored in facial paralysis reconstruction. A double-muscle transfer using a divided rectus femoris muscle for one-stage reconstruction of both the major zygomatic muscle and the depressor labii inferior muscle is described. The patient suffered facial paralysis caused by an extracranial schwannoma originating from the facial nerve. After the tumor was removed, divided rectus femoris muscle segments were transferred to reconstruct the major zygomatic muscle and the depressor labii inferior muscle. After the pedicle vessel of the muscles was anastomosed to the recipient facial vessel, the long motor nerve of the proximal divided muscle was cross-faced and coapted directly to the prepared contralateral buccal branch. The short motor nerve of the distal muscle segment was sutured to the ipsilateral masseteric nerve. The advantages of divided rectus femoris muscle transfers are that (1) independent muscle contraction can be reconstructed; (2) no tongue or trapezius muscle atrophy occurs because the masseteric nerve is used as the motor source of the labial depressor; (3) only one muscle is sacrificed for muscle grafts; and (4) it is a one-stage reconstruction.

Myectomy and Botulinum Toxin for Paralysis of the Marginal Mandibular Branch of the Facial Nerve: A Series of 76 Cases

“…2 However, it involves both a face-lift incision on the normal side and a submandibular incision on the affected side. Double muscle transfer for both depressor and elevator was described by Ueda et al 9 and Koshima et al 10 The donor-site morbidity, long microsurgical procedure, large muscle bulk, and synkinetic or dyskinetic muscle activity should still be considered.…”

Facial paralysis

“…29 The mimetic muscles are replaced by a single somatic voluntary muscle. 30 Several muscles have been used for this purpose, such as the gracilis, [31][32][33][34][35][36][37][38][39] pectoralis minor, 3,40 serratus anterior, 26 latissimus dorsi, 30,41 rectus abdominis, 42 rectus femoris, 43,44 extensor digitorum brevis, 45 and abductor hallucis muscles of the foot. 46 The most commonly transferred muscles are the gracilis and the pectoralis minor, especially in children.…”

The Surgical Management of Facial Nerve Injury

“…Using muscles such as the rectus femoris or latissimus dorsi, which have a long nerve pedicle, the muscle transfer and nerve coaptation to the contralateral facial nerve can be done at the same time. 49,50 Although the distance across which regenerating axons must travel is equal to that in the standard two-stage cross-facial nerve graft, groups performing one-stage operations report no problems with muscle reinnervation either clinically or by electromyographic data. 51 Muscular recovery has been reported as early as 6 months following one-stage operations.…”