Three-Dimensional Video Analysis of the Paralyzed Face Reanimated by Cross-Face Nerve Grafting and Free Gracilis Muscle Transplantation: Quantification of the Functional Outcome

Frey, Manfred; Michaelidou, Maria; Tzou, Chieh‐Han John; Pona, Igor; Mittlböck, Martina; Gerber, Hans; Stüssi, Edgar

doi:10.1097/prs.0b013e31818a9a8d

Cited by 62 publications

(53 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although in the most studies [1][2][3]5,6,14,16 on cross-face nerve graft the EEN is the technique used to connect the graft to the donor nerve, some authors [36][37][38] have shown that the ESN (technique more recently introduced 17 ) can also be used successfully. However, to date there is no consensus on the realization of reanimation of the facial paralysis in one or two surgical stages 2,4,9 .…”

Section: Discussionmentioning

confidence: 99%

“…However, its disadvantage is that muscle transplant remains denervated for a longer time waiting for axon growth through the nerve graft, which can result in atrophy of muscular fibers, jeopardizing the final result 15 . In the two-stage procedure, the muscle remains denervated for less time, because when it is transplanted, the axons had already grown to the distal end of the graft 2,3,5,6,16 .…”

Section: Introductionmentioning

confidence: 99%

“…End-to-end neurorrhaphy is commonly used in the crossface technique to connect the graft to the donor nerve, damaging some branches of the facial nerve on the healthy side [1][2][3]5,6,16 . The end-to-side neurorrhaphy without donor nerve lesion, introduced in 1992 by Viterbo et al 17 , has been increasingly used [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] and has the advantage of not injuring the donor nerve.…”

Section: Introductionmentioning

confidence: 99%

“…One end of the graft is sutured into a sectioned branch of the facial nerve on the healthy side. The other end is sutured to the nerve of the transplanted muscle, generally the gracilis muscle [1][2][3][4] , the pectoralis minor muscle 5,6 , or the latissimus dorsi muscle 7,8 , among others [9][10][11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Muscle reinnervation in one or two stages?: experimental study in rats with end-to-side nerve graft

et al. 2012

View full text Add to dashboard Cite

PURPOSE: To compare muscle reinnervation in one and two surgical stages using end-to-side neurorrhaphy (ESN) without donor nerve injury. METHODS: The experiment was performed on four groups of 20 rats. Group 1 (G1), one stage, received the graft which was sutured to the tibial nerve, with ESN, and its free stump was sutured end-to-end to the distal stump of the sectioned peroneal nerve (PN), all in the same operation. In Group 2 (G2), two stages, the nerve graft was sutured to the tibial nerve, with ESN. Two months later the PN was sectioned and its distal stump connected to the distal stump of the graft as in G1. Normal control group (Gn) received the graft only sutured to the tibial nerve, with ESN. Denervated control group (Gd), as well received the graft and had the PN sectioned and its two stumps buried in adjacent musculature, with the aim of denervating the cranial tibial muscle (CTM), the target of this study. The parameters used to evaluate CTM reinnervation were muscle mass, muscle fiber's minimum diameter and area. RESULTS: The mean CTM mass, the average of the muscular fibers areas and the average of the muscular fiber minimum diameters was higher (all p<0.0001) in G2 than in G1. Comparing the four groups, these parameters had their maximum expression in Gn and the minimum in Gd, as expected. CONCLUSION: The two stages showed better muscle reinnervation than one stage.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Muscle reinnervation in one or two stages?: experimental study in rats with end-to-side nerve graft

et al. 2012

View full text Add to dashboard Cite

show abstract

“…Draping a free-muscle flap over this convex bony landmark often creates a visible facial deformity. 4 This approach is less than ideal given that the purpose of facial nerve rehabilitation and reanimation is to reduce physical deformity. Many authors have reported successful volume reduction of the harvested gracilis flap as a modification to reduce this problem.…”

mentioning

confidence: 99%

Sternohyoid Flap for Facial Reanimation

Alam

Haffey

Vakharia

et al. 2013

JAMA Facial Plast Surg

View full text Add to dashboard Cite

IMPORTANCE Neuromuscular reanimation of the face provides the correct specific neural functional input and thereby prevents synkinesis. Unfortunately, this ideal situation is rarely encountered in the clinical setting.OBJECTIVES To assess the technical feasibility of and define the surgical procedure for harvesting the sternohyoid muscle as a novel free flap for use in facial reanimation indications.DESIGN, SETTING, AND PARTICIPANTS Fresh, postmortem, nonfixed cadavers were used to define the anatomy and perform the flap harvest procedures. Twenty-four flap harvests were performed. Angiography was performed on the pedicle of the harvested flaps to assess potential flap perfusion. Adenosine triphosphatase staining was performed on the muscle specimens to establish fiber type. MAIN OUTCOME MEASURESThe harvest technique, pedicle (arterial or venous), nerve length, and flap geometry parameters were characterized. RESULTSThe sternohyoid muscle was found to be reliably vascularized by the superior thyroid artery in all cases with an appropriate arterial and venous pedicle for vascular anastomosis. The mean arterial (5.5 cm) and venous (5.9 cm) pedicle lengths are comparable with gracilis flaps. The mean motor nerve length was 10.7 cm. The inclusion of the hyoid bone allows rigid fixation, and the muscle size, fiber type, and volume profiles all compare favorably to the gracilis flap for use in the indication of facial reanimation. Mock surgical procedures were performed to define inset parameters. This flap potentially allows single-stage cross-facial neurorrhaphies to be performed.CONCLUSIONS AND RELEVANCE This is the first article, to our knowledge, of the sternohyoid muscle as a potential donor site for free-tissue transfer. This muscle has a predictable vascular pedicle and neural innervation along with size and fiber type parameters that make it an ideal potential free flap for facial reanimation.LEVEL OF EVIDENCE NA.

show abstract

Assessing Outcomes in Facial Reanimation: Evaluation and Validation of the SMILE System for Measuring Lip Excursion During Smiling

Bray

Henstrom

Cheney

et al. 2010

Archives of Facial Plastic Surgery

View full text Add to dashboard Cite

Three-Dimensional Video Analysis of the Paralyzed Face Reanimated by Cross-Face Nerve Grafting and Free Gracilis Muscle Transplantation: Quantification of the Functional Outcome

Abstract: Three-dimensional video analysis provided an exact quantitative documentation of the degree of facial palsy preoperatively and the reconstructed movements. The value of free functional gracilis muscle transplantation was demonstrated for both variations of the technique.

Cited by 62 publications

References 25 publications

Muscle reinnervation in one or two stages?: experimental study in rats with end-to-side nerve graft

Muscle reinnervation in one or two stages?: experimental study in rats with end-to-side nerve graft

Sternohyoid Flap for Facial Reanimation

Assessing Outcomes in Facial Reanimation: Evaluation and Validation of the SMILE System for Measuring Lip Excursion During Smiling

Contact Info

Product

Resources

About