One-stage dual latissimus dorsi muscle flap transfer with a pair of vascular anastomoses and double nerve suturing for long-standing facial paralysis

Okazaki, Mutsumi; Tanaka, Kentaro; Uemura, Naomi; Usami, Satoshi; Homma, Tsutomu; Okubo, Akiko; Hamanaga, Mayuko; Mori, Hiroki

doi:10.1016/j.bjps.2015.02.013

Cited by 26 publications

(20 citation statements)

References 18 publications

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“…In recent years, various double muscle transfer methods have been reported for long-standing facial paralysis, in which each muscle flap is reinnervated by two neural motor sources to reproduce complex perioral movements. Okazaki et al [10] demonstrated dual latissimus dorsi muscle flap transfer with nerve suturing to the ipsilateral masseteric and contralateral facial nerves. Although this method using two muscle flaps mimics complex facial movements and guarantees reliable muscle contraction and voluntary smiling in one stage, it is difficult to produce a coordinated smile due to the independent innervation of each muscle flap.…”

Section: Discussionmentioning

confidence: 99%

Dual-innervated multivector muscle transfer using two superficial subslips of the serratus anterior muscle for long-standing facial paralysis

et al. 2021

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Recent reports have described several cases of double muscle transfers to restore natural, symmetrical smiles in patients with long-standing facial paralysis. However, these complex procedures sometimes result in cheek bulkiness owing to the double muscle transfer. We present the case of a 67-year-old woman with long-standing facial paralysis, who underwent two-stage facial reanimation using two superficial subslips of the serratus anterior muscle innervated by the masseteric and contralateral facial nerves via a sural nerve graft. Each muscle subslip was transferred to the upper lip and oral commissures, which were oriented in different directions. Furthermore, a horizontal fascia lata graft was added at the lower lip to prevent deformities such as lower lip elongation and deviation. Voluntary contraction was noted at roughly 4 months, and a spontaneous smile without biting was noted 8 months postoperatively. At 18 months after surgery, the patient demonstrated a spontaneous symmetrical smile with adequate excursion of the lower lip, upper lip, and oral commissure, without cheek bulkiness. Dual-innervated muscle transfer using two multivector superficial subslips of the serratus anterior muscle may be a good option for long-standing facial paralysis, as it can achieve a symmetrical smile that can be performed voluntarily and spontaneously.

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Section: Discussionmentioning

confidence: 99%

Dual-innervated multivector muscle transfer using two superficial subslips of the serratus anterior muscle for long-standing facial paralysis

et al. 2021

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“…The second advantage of the described technique is that the 2 flaps were transplanted at different angles to create multivector movements, which are essential for animating a natural smile. Okazaki et al () reported a one‐stage multiple muscle flap transfer with a divided LD flap for smile reanimation but found 2 disadvantages: slight difficulty in harvesting the divided flap depending on the neurovascular anatomy and irregularity of flap contraction. Yoleri () reported smile reanimation by transferring multiple slips of the SA muscle, but this technique is a two‐stage technique and requires a sural nerve graft to the contralateral FN.…”

Section: Discussionmentioning

confidence: 99%

One‐stage reconstruction by dual‐innervated double muscle flap transplantation with the neural interconnection between the ipsilateral masseter and contralateral facial nerve for reanimating established facial paralysis: A report of 2 cases

et al. 2018

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The authors developed a one‐stage double‐muscle reconstruction technique for facial paralysis using a latissimus dorsi (LD) flap and a serratus anterior (SA) flap, which were dually reinnervated by the contralateral facial nerve (FN) and ipsilateral masseter nerve (MN). The procedure was performed for 61‐year‐old man 3‐years after resection of a malignant tumor and a 24‐year‐old woman 10‐years after temporal fracture with facial paralysis. A double‐muscle flap comprising left LD and SA flaps was harvested, a 15‐cm thoracodorsal nerve (TN) section was attached to the LD flap, and 5‐cm and 1‐cm sections of the long thoracic nerve (LTN) were attached to the proximal and distal sides of SA flap. The LD flap and SA flap were sutured along the direction of motion of the zygomaticus major and risorius muscles, respectively. The contralateral FN and ipsilateral MN were interconnected by nerve suturing: the medial branch of TN to the distal end of LTN, the proximal end of LTN to the ipsilateral MN, and the buccal branch of contralateral FN to the main trunk of TN. After surgery, good contraction of the transferred flaps resulted in reanimation of a natural symmetrical smile; no complications were observed during the 12‐month follow‐up period.

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“…We previously reported the 1-stage dual latissimus dorsi muscle flap transfer with a pair of vascular anastomoses and double nerve suturing for smile reconstruction. 7 In the method, 2 muscle flaps based on the descending and transverse branches of the thoracodorsal vessels are transferred to the cheek for smile reconstruction. The true trunk of the thoracodorsal nerve, which innervates 1 muscle flap, is sutured to the contralateral facial nerve, whereas the short branch of the thoracodorsal nerve, which innervates the other muscle flap, is sutured to the ipsilateral masseteric nerve.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Surgical Treatment for Smile Dysfunction and Lagophthalmos Involving a Dual Latissimus Dorsi Flap

Homma

Okazaki

Tanaka

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Summary:Paralytic lagophthalmos and smile dysfunction are serious complications of facial paralysis and various reconstructive procedures have been developed to treat them. Among these procedures, there is no doubt that dynamic procedures are more effective than static ones. The 1-stage simultaneous surgical treatment of these 2 dysfunctions with a dynamic procedure involving a single muscle would be ideal, but no such methods have been reported. In this article, we present a 1-stage method for the simultaneous surgical treatment involving the use of a dual latissimus dorsi muscle flap. In this method, 2 muscle flaps based on the descending and transverse branches of the thoracodorsal vessels are transferred to the face. The descending and transverse branches of the thoracodorsal nerve are sutured to separate branches of the masseteric nerve. Using this method, complete eyelid closure during strong clenching and voluntary smiling during weak clenching without eyelid closure were achieved. Although our method does not result in spontaneous smiling, we believe that it is a good option for some patients with long-standing facial paralysis.

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One-stage dual latissimus dorsi muscle flap transfer with a pair of vascular anastomoses and double nerve suturing for long-standing facial paralysis

Cited by 26 publications

References 18 publications

Dual-innervated multivector muscle transfer using two superficial subslips of the serratus anterior muscle for long-standing facial paralysis

Dual-innervated multivector muscle transfer using two superficial subslips of the serratus anterior muscle for long-standing facial paralysis

One‐stage reconstruction by dual‐innervated double muscle flap transplantation with the neural interconnection between the ipsilateral masseter and contralateral facial nerve for reanimating established facial paralysis: A report of 2 cases

Simultaneous Surgical Treatment for Smile Dysfunction and Lagophthalmos Involving a Dual Latissimus Dorsi Flap

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