Eyelid reanimation using crossface nerve graft: Relationship between surgical outcome and preoperative paralysis duration

Okochi, Masayuki; Okochi, Hiromi; Asai, Emiko; Sakaba, Takao

doi:10.1002/micr.30264

Cited by 5 publications

(2 citation statements)

References 27 publications

(48 reference statements)

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“…A wide range of surgical techniques have been introduced for restoring eye closure, including static techniques such as upper lid loading with gold weight or spring, fascial sling, and lateral/medial tarsorrhaphy [18][19][20] and dynamic reanimation using muscle-based techniques (local muscle transfer) 21,22) , 23,24) , or nerve transfer with muscle graft [24][25][26][27] , and FFMT [6][7][8] . Platysma FFMT for eye closure/blink has been proven effective [6][7][8] .…”

Section: Motivation Of the Special Designmentioning

confidence: 99%

Single Gracilis Functioning Free Muscle Transplantation for Simultaneous and Combined Reconstruction of Smile and Lagophthalmos in Complete Facial Paralysis

Chuang

Chang

2022

JPRS

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Objectives: Loss of smile and inability of eye closure are coexisting features of complete facial paralysis. Both reconstructions are commonly performed separately. In this study, we present an option of using one gracilis functioning free muscle transplantation for the simultaneous and combined reconstruction of smile and lagophthalmos. Methods: A retrospective review was performed from an institutional database for facial paralysis. The gracilis for functioning free muscle transplantation was split into three portions, namely the upper gracilis was used for smile, the lower gracilis was used for eye closure, and the central gracilis was used for maintenance of vasculature. Intramuscular dissection of the obturator nerve was performed to create two motor neurotizers. The design was to adopt one muscle with two functioning free muscle transplantations for two functions, i.e., smile and eye closure. Results: A total of five patients with unilaterally complete facial palsy, which resulted from acoustic neuroma resection, were enrolled. All patients had a follow-up of at least 1 year. The smile score improved from 0 (no tooth visible) up to 3+ (at least three teeth visible). The eye closure improved from 9-11 mm to 0-6 mm in interpalpebral distance. Conclusions: Based on the technique of intramuscular nerve dissection and division, one gracilis functioning free muscle transplantation can be split into upper and lower gracilis for two functioning free muscle transplantations with the preservation of the central part of the vasculature. The surgical strategy proves that it is theoretically and clinically applicable for simultaneous and combined reconstruction of smile and eye closure with only one nutrient vessel anastomosis.

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Section: Motivation Of the Special Designmentioning

confidence: 99%

Single Gracilis Functioning Free Muscle Transplantation for Simultaneous and Combined Reconstruction of Smile and Lagophthalmos in Complete Facial Paralysis

Chuang

Chang

2022

JPRS

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“…This inability to close the eye can cause increased corneal exposure, increasing the risk of corneal abrasions, epiphora, and possible loss of vision. 1 , 2 Static and dynamic procedures can be used to restore the function of the eyelid and protect the globe from further injury. Previous studies have shown that muscles that are not reinnervated by 2 years after injury will undergo permanent atrophy, requiring replacement of new muscle due to lost motor units.…”

mentioning

confidence: 99%

Eyelid Reanimation with Free Platysma Graft: Final Stage of Reconstruction after Gunshot Wound to Face

Hart

Gupta

Chaiyasate

2022

Plastic and Reconstructive Surgery - Global Open

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Summary: Patients with gunshot wounds to the face have massive soft tissue and bony damage from projectile and blast injuries. They often require multiple, staged reconstructive surgeries with cross-facial nerve grafting and free muscle flap for re-establishment of facial expression. Injury to or total loss of the facial nerve and branches can result in loss of function of the orbicularis oculi muscle, which leads to the loss of protective mechanisms of eyelid function and blink reflex. The purpose of this article is to provide a literature review and discussion of eyelid reanimation after facial paralysis and to discuss our surgical technique with free platysma muscle grafts of the eyelid. The patient is a 45-year-old man with a history of a gunshot wound to the right face. He underwent multiple reconstructive surgeries in the past, and in preparation for eyelid reanimation, he underwent a cross-facial nerve graft from the left temporal branch to the right eyelid. At initial postoperative evaluation, the patient was able to close his right eye with minimal lagophthalmos, and at 3-month follow-up, he exhibited stronger blinking reflex. This case demonstrates that a free platysma graft with direct neurotization with cross-facial nerve graft fascicles can be utilized for restoration of spontaneous eyelid animation. However, there may be failure of neurotization and inability of the spontaneous blink reflex to be present. Despite these limitations, we still recommend the utilization of free platysma graft to provide upper eyelid reanimation through cross-facial nerve graft.

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Comparison between VII-to-VII and XII-to-VII coaptation techniques for early facial nerve reanimation after surgical intra-cranial injuries: a systematic review and pooled analysis of the functional outcomes

et al. 2020

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Eyelid reanimation using crossface nerve graft: Relationship between surgical outcome and preoperative paralysis duration

Abstract: To achieve successful results with CFNG, surgery should be performed within 6 months of the onset of paralysis.

Cited by 5 publications

References 27 publications

Single Gracilis Functioning Free Muscle Transplantation for Simultaneous and Combined Reconstruction of Smile and Lagophthalmos in Complete Facial Paralysis

Single Gracilis Functioning Free Muscle Transplantation for Simultaneous and Combined Reconstruction of Smile and Lagophthalmos in Complete Facial Paralysis

Eyelid Reanimation with Free Platysma Graft: Final Stage of Reconstruction after Gunshot Wound to Face

Comparison between VII-to-VII and XII-to-VII coaptation techniques for early facial nerve reanimation after surgical intra-cranial injuries: a systematic review and pooled analysis of the functional outcomes

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