Surgeons have found it difficult to quantify facial paralysis and its improvement by reconstructive surgery. This article presents the results achieved by free functional muscle transplantation for reconstruction of the paralyzed face, registered by three-dimensional video analysis of facial movements.
Of patients treated consecutively between 1997 and 2006, two groups were constituted: group 1 comprised 22 patients with reinnervation completed after a single cross-face nerve graft and a free gracilis muscle graft for reconstruction of the smile; group 2 comprised nine patients treated with two cross-face nerve grafts followed by a territorially differentiated gracilis muscle transplant for reconstruction of the smile and eye closure. Smiling with showing teeth, maximal showing of teeth, and closing the eyes as in sleep were analyzed in detail.
In group 1, static asymmetry was reduced from 12.19 ± 8.73 mm preoperatively to −1.84 ± 7.67 mm at 18 months postoperatively. Smile amplitude increased from 9 to 60 percent of that on the healthy side in 10 incomplete facial palsies of this group, and from 0 to 62 percent in eight functionally successful muscle grafts among 11 patients with complete lesions. In group 2, static asymmetry improved from 7.24 ± 12.64 mm to −5.36 ± 9.07 mm; the overcorrection was intentional. Movement was improved in eight cases. Smile amplitude reached 68 ± 43 percent of that on the normal side. Lagophthalmus improved from 7.21 ± 3.59 mm to 1.38 ± 2.49 mm. All improvements were statistically significant (p ≤ 0.05).
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.
Vienna, Austria; and Zurich, Switzerland
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, General Hospital Vienna; the Laboratory for Biomechanics, Swiss Federal Institute of Technology; and the Core Unit for Medical Statistics and Informatics, Section of Clinical Biometry, Medical University of Vienna.
Received for publication December 9, 2007; accepted June 27, 2008.
Disclosure:The tools used for three-dimensional video analysis were developed by the authors as part of a cooperative research project conducted jointly by their institutions. The authors have no commercial interest in these instruments.
Manfred Frey, M.D.; Division of Plastic and Reconstructive Surgery; Medical University of Vienna; Waehringer Guertel 18-20; A-1090 Vienna, Austria; firstname.lastname@example.org