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Cross-Face Neurotized Platysmal Muscular Graft for Upper Eyelid Reanimation: An Anatomic Feasibility Study

Hontanilla, Bernardo MD, PhD,; Marre, Diego MD,; Cabello, Álvaro MD

Journal of Craniofacial Surgery: March 2014 - Volume 25 - Issue 2 - p 623–625
doi: 10.1097/SCS.0000000000000503
Anatomical Studies

Background Upper eyelid reanimation is one of the most important aspects of facial paralysis. The ideal method would be one that provided dynamic restoration of voluntary eye closure, involuntary blinking, and corneal reflex. Innervation to the platysma has shown to be relatively consistent, which would allow its use as a muscle graft neurotized by the contralateral healthy facial nerve for eyelid reanimation.

Methods Six fresh cadavers, 12 sides, were studied by dissecting the main trunk of the facial nerve and its cervicofacial division. Special attention was paid at the emergence of cervical branches to the platysma and its distribution on the undersurface of the muscle as well as its relationships with regional anatomic references.

Results One major branch with 1 or 2 accessory branches was found to emerge from the cervicofacial division, 1.5 cm distal to its origin in the facial nerve trunk. The major branch showed an oblique course, starting approximately 1 cm below the angle of the mandible and coursing toward the inferomedial border of the muscle. Harvest of a 3 × 2 muscle piece with a 10-cm–long neural pedicle was possible in all specimens. When presented over the superior eyelid, the nerve branch was found to reach the contralateral frontal branch of the facial nerve.

Conclusions Innervation to the platysma muscle is relatively constant and consists of 1 major branch accompanied by 1 or 2 accessory branches. Harvest of a muscle flap with a neural pedicle long enough to reach the contralateral healthy side is anatomically feasible.

From the Department of Plastic and Reconstructive Surgery, Clinica Universidad de Navarra, Pamplona, Spain.

Received May 9, 2013.

Accepted for publication October 28, 2013.

Address correspondence and reprint requests to Dr. Bernardo Hontanilla, Department of Plastic and Reconstructive Surgery, Clinica Universidad de Navarra, Av. Pio XII 36, 31008, Pamplona, Spain; E-mail:

There was no source of funds supporting this work; the authors have no financial interest in the methodology described.

The authors report no conflicts of interest.

© 2014 by Mutaz B. Habal, MD.