Microsurgical Strategies in 74 Patients for Restoration of Dynamic Depressor Muscle Mechanism: A Neglected Target in Facial Reanimation

Anterior belly of digastric muscle transfer: A useful technique in head and neck surgery

“…8,9 Several treatment strategies have been proposed to restore symmetry, including myotomy and myomectomy of the ipsilateral elevators of the paralyzed side or of the depressors of the normal FIGURE 1. A 32-year-old woman had an MMBFN palsy and Frey's syndrome after a super®cial parotidectomy for a pleomorphic adenoma in the left parotid gland.…”

"O uso da toxina botulínica em doentes com hipercinesia muscular facial contralateral à paralisia facial"

“…Facial symmetry is often enhanced in static state, but the dynamics are still imbalanced due to the absence of movement on the paralyzed hemiface and the hyperkinesis on the opposite side (39). In addition, treatment of contralateral hyperkinesis by neurectomies, myectomies or myotomies may produce complications such as paresthesia, hyperesthesia, partial paresis, asymmetry, and incomplete corrections and recurrence, without achieving appropriate facial balance (13,14,(40)(41)(42).…”

“…Current techniques for treating facial paralysis include nerve grafts, muscle transfers, myofunctional approach, and microsurgical patches, which unfortunately are not able to grant the patient facial balance (7)(8)(9)(10)(11)(12)30). The best results are obtained through a variety of techniques, including reducing the hyperactivity (hyperkinesis) of the nonaffected side through selective myotomy, myectomy, or neurectomy (13,14). The addition of techniques for suspending or resecting skin, such as rhytidectomy, blepharoplasty, and correction of lagophthalmos, can further improve the aesthetic results (15)(16)(17)(18).…”

“…Na fase aguda, pode ser realizado com dexametasona com ou sem a associação de anti-viral 11 . Após essa fase, o tratamento inclui enxertos de nervos, transferências musculares, retalhos microcirúrgicos, enfim, múltiplas formas de tratamento que não conseguem dar ao paciente, o equilíbrio desejado para a face 12,13,14,15,16 . Mesmo após todas essas intervenções, podem surgir sincinesias associadas aos tratamentos anteriormente descritos que complicam ainda mais a reabilitação dos portadores de paralisia facial 17,18 .…”

“…A menor distância entre as duas medidas deu-se no Dia 28. Apesar de todos os tipos de tratamentos citados, os resultados estéticos e funcionais dos procedimentos cirúrgicos são imprevisíveis e às vezes não conseguem dar ao paciente o equilíbrio facial 13,14,70 . A simetria estática pode ser freqüentemente melhorada, porém a assimetria dinâmica permanece devido ao desequilíbrio da coordenação dos movimentos da expressão facial 6,71 .…”