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Outcomes of Direct Muscle Neurotization in Pediatric Patients with Facial Paralysis

Terzis, Julia K. M.D., Ph.D.; Karypidis, Dimitrios M.D.

Plastic and Reconstructive Surgery: November 2009 - Volume 124 - Issue 5 - p 1486-1498
doi: 10.1097/PRS.0b013e3181b98924
Reconstructive: Head and Neck: Original Articles

Background: Multistage reconstructive procedures are often required to try to restore the emotional potential of human expression in cases of facial paralysis. In this study, the senior author’s (J.K.T.) experience with the technique of direct nerve to muscle neurotization as a part of multistage facial reanimation procedures is presented. Age, denervation time, etiology of the lesion, previous reconstructive procedures, and types of muscles responsible for animation were analyzed to make evidence-based recommendations on the indications of the technique as well as its role and effectiveness in facial reanimation.

Methods: Retrospective review of 37 pediatric patients who underwent direct muscle neurotization took place. The patients were divided into three groups, depending on the region that direct neurotization was aiming to augment. Group A involved 28 patients for eye closure and blink, group B included 15 patients for smile, and group C included 19 patients for depressor augmentation.

Results: Twenty patients were female and 17 male. Patient age ranged from 1 to 16 years, with a mean age (±SD) of 9 ± 2.8 years. Denervation time ranged from 3 months to 15.25 years, and the mean denervation time was 6.72 years. Electromyographic scoring of the neurotized muscles showed an overall mean improvement of 36 percent for eye closure, 34.25 percent for blink, 37 percent for smile augmentation, and 30 percent for depressor function restoration.

Conclusion: Direct muscle neurotization has a valid role in pediatric facial reanimation procedures, as it augments and promotes expressivity.

Norfolk, Va.

From the Department of Surgery, Division of Plastic and Reconstructive Surgery, and the Microsurgery Program, Eastern Virginia Medical School.

Received for publication July 31, 2008; accepted April 1, 2009.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Julia K. Terzis, M.D., Ph.D., Department of Surgery, Division of Plastic and Reconstructive Surgery, Microsurgery Program Eastern Virginia Medical School, Lewis Hall, Room 2055 Norfolk, Va. 23501,

©2009American Society of Plastic Surgeons