Abstract
Restoration of spontaneous, synchronous and powerful facial movement is the main aim of facial reanimation surgery. The gold standard surgical treatment for long-standing unilateral facial paralysis is a 2-stage reconstruction with cross-facial nerve graft (CFNG) followed by free muscle transfer. Although spontaneity and synchronicity is achieved with this technique, the power of contraction may be weaker than desired. The dual innervation of free gracilis muscle transfer aims to examine the effect of the simultaneous use of CFNG (to provide coordination) and masseteric nerve (to provide powerful contraction). The senior author has been performing the dual innervation since August 2012 on a selected number of patients and believes it is a useful method of reanimation on patients who have had other failed procedures, “heavy” faces and when an expedited re-animation is required or expected.
This is a preview of subscription content, log in via an institution.
References
Biglioli F, Colombo V, Tarabbia F, Pedrazzoli M, Battista V, Giovanditto F, Dalla Toffola E, Lozza A, Frigerio A. Double innervation in free-flap surgery for long-standing facial paralysis. J Plast Reconstr Aesthet Surg. 2012;65(10):1343–9.
Borschel GH, Kawamura DH, Kasukurthi R, Hunter DA, Zuker RM, Woo AS. The motor nerve to the masseter muscle: an anatomic and histomorphometric study to facilitate its use in facial reanimation. J Plast Reconstr Aesthet Surg. 2012;65(3):363–6.
Conley J. Hypoglossal crossover--122 cases. Trans Sect Otolaryngol Am Acad Ophthalmol Otolaryngol. 1977;84(4 Pt 1):ORL-763–8.
Faria JC, Scopel GP, Busnardo FF, Ferreira MC. Nerve sources for facial reanimation with muscle transplant in patients with unilateral facial palsy: clinical analysis of 3 techniques. Ann Plast Surg. 2007;59(1):87–91.
Fattah AY, Ravichandiran K, Zuker RM, Agur AM. A three-dimensional study of the musculotendinous and neurovascular architecture of the gracilis muscle: application to functional muscle transfer. J Plast Reconstr Aesthet Surg. 2013;66(9):1230–7.
Hwang K, Kim YJ, Chung IH, Song YB. Course of the masseteric nerve in masseter muscle. J Craniofac Surg. 2005;16(2):197–200.
Morris SF, Yang D. Gracilis muscle: arterial and neural basis for subdivision. Ann Plast Surg. 1999;42(6):630–3.
Terzis JK, Olivares FS. Long-term outcomes of free-muscle transfer for smile restoration in adults. Plast Reconstr Surg. 2009;123(3):877–88.
Terzis JKT, Tzafetta K. Facial Reanimation. In: Plastic surgery: indications and practice, Bahman Guyuron EE, John Persing, Kevin Chung, Joseph Disa, Arun Gosain, Brian Kinney, J Peter Rubin (ed), vol. 1. Edinburgh: Saunders Elsevier; 2009. p. 907.
Tzafetta K, Al-Hassani F, Pinto-Lopez R, Wade RG, Ahmad Z. Long term outcomes of dual innervation in functional muscle transfers for facial palsy. J Plast Reconstr Aesthet Surg (accepted March 2021).
Watanabe Y, Akizuki T, Ozawa T, Yoshimura K, Agawa K, Ota T. Dual innervation method using one-stage reconstruction with free latissimus dorsi muscle transfer for re-animation of established facial paralysis: simultaneous reinnervation of the ipsilateral masseter motor nerve and the contralateral facial nerve to improve the quality of smile and emotional facial expressions. J Plast Reconstr Aesthet Surg. 2009;62(12):1589–97.
Author information
Authors and Affiliations
Section Editor information
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this entry
Cite this entry
Tzafetta, K., Sofos, S. (2020). Adult Facial Palsy Reconstruction: Dual innervation of gracilis muscle. In: Clinical Scenarios in Reconstructive Microsurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-94191-2_31-1
Download citation
DOI: https://doi.org/10.1007/978-3-319-94191-2_31-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-94191-2
Online ISBN: 978-3-319-94191-2
eBook Packages: Springer Reference MedicineReference Module Medicine