Lower Lip Reanimation: Experience Using the Anterior Belly of Digastric Muscle in 2-stage Procedure

Tzafetta, Kallirroi; Ruston, Julia; Pinto-Lopes, Rui; Mabvuure, Nigel Tapiwa

doi:10.1097/gox.0000000000003461

Cited by 10 publications

(11 citation statements)

References 22 publications

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“…In the case of longstanding lower lip paralysis, Tzafetta et al recommend a two-stage technique, first using a cross-facial nerve graft and then the transposition of the anterior belly of the digastric muscle (ABDM), innervated by the cross-facial nerve graft [ 62 ]. The authors managed to significantly improve lower lip height and symmetry, smile angle, and dental show [ 63 ].…”

Section: Resultsmentioning

confidence: 99%

“…Lower lip depressors are responsible for the subtle movement of the lower lip, playing a significant role in full-denture smiles and phonetics [ 63 ]. Contemporary management of lip depressor palsy depends on whether flaccid paralysis or synkinetic (non-flaccid) palsy is present [ 81 , 82 ].…”

Section: Resultsmentioning

confidence: 99%

“…Although there are numerous hypothesized mechanisms for synkinesis, nonspecific aberrant regeneration of nerves due to ineffective myelination and reorganization of neural networks during regrowth is the predominant theory [ 73 , 74 ]. Synkinetic lower lip depressor muscles can be managed with ipsilateral weakening of the depressor anguli oris muscle, either through botulinum toxin injections, marginal mandibular nerve neurectomy, or depressor labii inferioris myomectomy [ 1 , 63 ]. Botulinum toxin type A (BTX-A) injections impermanently paralyze muscles by blocking acetylcholine release at the neuromuscular junction, allowing one to improve synkinesis on the affected side and reduce hyperkinesis of the face on the unaffected side [ 81 , 82 ].…”

Section: Resultsmentioning

confidence: 99%

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A Comprehensive Approach to Facial Reanimation: A Systematic Review

Pinkiewicz

Dorobisz

Zatoński

2022

JCM

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Purpose: To create a systematic overview of the available reconstructive techniques, facial nerve grading scales, physical evaluation, the reversibility of paralysis, non-reconstructive procedures and medical therapy, physical therapy, the psychological aspect of facial paralysis, and the prevention of facial nerve injury in order to elucidate the gaps in the knowledge and discuss potential research aims in this area. A further aim was to propose an algorithm simplifying the selection of reconstructive strategies, given the variety of available reconstructive methods and the abundance of factors influencing the selection. Methodological approach: A total of 2439 papers were retrieved from the Medline/Pubmed and Cochrane databases and Google Scholar. Additional research added 21 articles. The primary selection had no limitations regarding the publication date. We considered only papers written in English. Single-case reports were excluded. Screening for duplicates and their removal resulted in a total of 1980 articles. Subsequently, we excluded 778 articles due to the language and study design. The titles or abstracts of 1068 articles were screened, and 134 papers not meeting any exclusion criterion were obtained. After a full-text evaluation, we excluded 15 papers due to the lack of information on preoperative facial nerve function and the follow-up period. This led to the inclusion of 119 articles. Conclusions: A thorough clinical examination supported by advanced imaging modalities and electromyographic examination provides sufficient information to determine the cause of facial palsy. Considering the abundance of facial nerve grading scales, there is an evident need for clear guidelines regarding which scale is recommended, as well as when the postoperative evaluation should be carried out. Static procedures allow the restoral of facial symmetry at rest, whereas dynamic reanimation aims to restore facial movement. The modern approach to facial paralysis involves neurotization procedures (nerve transfers and cross-facial nerve grafts), muscle transpositions, and microsurgical free muscle transfers. Rehabilitation provides patients with the possibility of effectively controlling their symptoms and improving their facial function, even in cases of longstanding paresis. Considering the mental health problems and significant social impediments, more attention should be devoted to the role of psychological interventions. Given that each technique has its advantages and pitfalls, the selection of the treatment approach should be individualized in the case of each patient.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A Comprehensive Approach to Facial Reanimation: A Systematic Review

Pinkiewicz

Dorobisz

Zatoński

2022

JCM

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“…Cross facial nerve grafts (CFNGs) are one of the most ubiquitous and time-honored surgical tools used in facial reanimation. 1–5 They may be used for targeting different mimetic muscles in varied facial subunits, such as the periorbita, midface, and lower lip, 6–10 in both the acute and subacute settings, complementing “babysitter” strategies, or for innervating free functional muscle transfers (FFMTs) and even grafts in long-standing paralysis. 11–14…”

Section: Introductionmentioning

confidence: 99%

“…Cross facial nerve grafts (CFNGs) are one of the most ubiquitous and time-honored surgical tools used in facial reanimation. [1][2][3][4][5] They may be used for targeting different mimetic muscles in varied facial subunits, such as the periorbita, midface, and lower lip, [6][7][8][9][10] in both the acute and subacute settings, complementing "babysitter" strategies, or for innervating free functional muscle transfers (FFMTs) and even grafts in long-standing paralysis. [11][12][13][14] Traditionally, CFNG is transferred to the contralateral face through the upper lip in a subcutaneous, submucosal, [15][16][17] or periosteal tunnel 12,18 and banked directly in front of the preauricular incision in a straight line, usually tagged and tacked in place with a large identifiable permanent suture.…”

Section: Introductionmentioning

confidence: 99%

Cross Facial Nerve Grafting for Smile Restoration: Thoughts on Improving Graft Inset

Evgeniou

Mitchell

Rozen

2022

Plastic and Reconstructive Surgery - Global Open

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Summary: Cross facial nerve grafts (CFNGs) are one of the most ubiquitous and time-honored surgical tools used in facial reanimation. They may be used for targeting different mimetic muscles in the subacute setting as well as to innervate newly placed muscle flaps in varied facial subunits. In our experience, when used specifically for smile reanimation in two-stage strategies with either traditional “babysitting” approaches in nerve transfers or free functional muscle transfers, the second stage may present some challenges in CFNG identification as well as injury to the previously banked nerve graft. We present some technical modifications in the first-stage CFNG inset that can make the second stage easier and safer. These modifications include: (1) marking the course of the nerve graft with surgical metal clips and inserting loose circumferential sutures throughout the distal course of the nerve in the recipient area to avoid displacement; (2) transferring the nerve graft through the nasal sills rather than lips, protecting it from damage during insertion of free functional muscle transfer; and (3) routing the nerve from the lateral nose to the preauricular area over the zygomatic arch, allowing easier dissection and banking of adequate graft length to provide tension-free coaptation with the flexibility of nerve coaptation in variable positions.

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Selective ansa cervicalis nerve transfer to the marginal mandibular nerve for lower lip reanimation: An anatomical study in cadavers and a case report

et al. 2022

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Background Donor nerve options for lower lip reanimation are limited in patients undergoing oncological resection of the facial nerve. The ansa cervicalis nerve (ACN) is an advantageously situated donor with great potential but has not been examined in detail. In the current study, the anatomical technical feasibility of selective ACN to marginal mandibular nerve (MMN) transfer for restoration of lower lip tone and symmetry was explored. A clinical case is presented. Methods Dissections were conducted in 21 hemifaces in non‐embalmed human cadavers. The maximal harvestable length of ACN was measured and transfer to MMN was simulated. A 28‐year‐old male underwent ACN‐MMN transfer after parotidectomy (carcinoma) and was evaluated 12 months post‐operatively (modified Terzis' Lower Lip Grading Scale [25 observers] and photogrammetry). Results The harvestable length of ACN was 100 ± 12 mm. A clinically significant anatomical variant (“short ansa”) was present in 33% of cases (length: 37 ± 12 mm). Tensionless coaptation was possible in all cases only when using a modification of the surgical technique in “short ansa” cases (using an infrahyoid muscle nerve branch as an extension). The post‐operative course of the clinical case was uneventful without complications, with improvement in tone, symmetry, and function at the lower lip at 12‐month post‐operative follow‐up. Conclusions Selective ACN‐MMN nerve transfer is anatomically feasible in facial paralysis following oncological ablative procedures. It allows direct nerve coaptation without significant donor site morbidity. The clinical case showed good outcomes 12 months post‐operatively. A strategy when encountering the “short ansa” anatomical variant in clinical cases is proposed.

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Lower Lip Reanimation: Experience Using the Anterior Belly of Digastric Muscle in 2-stage Procedure

Abstract: Supplemental Digital Content is available in the text.

Cited by 10 publications

References 22 publications

A Comprehensive Approach to Facial Reanimation: A Systematic Review

A Comprehensive Approach to Facial Reanimation: A Systematic Review

Cross Facial Nerve Grafting for Smile Restoration: Thoughts on Improving Graft Inset

Selective ansa cervicalis nerve transfer to the marginal mandibular nerve for lower lip reanimation: An anatomical study in cadavers and a case report

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