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Novel Use of C7 Spinal Nerve for Moebius

Terzis, Julia K. M.D., Ph.D.; Konofaos, Petros M.D.

Plastic and Reconstructive Surgery: July 2010 - Volume 126 - Issue 1 - p 106-117
doi: 10.1097/PRS.0b013e3181dbbd79
Reconstructive: Head and Neck: Original Articles

Background: The purpose of this study was to introduce the use of selective ipsilateral C7 spinal nerve transfer to the armamentarium of the dynamic procedures used for facial reanimation in Moebius patients.

Methods: Between 1991 and 2007, the selective ipsilateral C7 technique was used in four patients. In three patients with bilateral paralysis, both C7 spinal nerves were utilized as nerve donors. Thus, evaluation of outcomes was carried out in seven hemifaces.

Results: Short-term paresthesia on the index pulp of the donor upper extremity was observed in four limbs, which recovered spontaneously. Motor deficits were never noticed. Neurotization of the free-muscle transfer for smile was performed in five hemifaces, with good results in three hemifaces (p < 0.01, z = 2.61). Eye closure neurotization was made in six hemifaces, with good results in four hemifaces (p < 0.01, z = 2.88). Depressor neurotization was made in one case and resulted in improved depressor complex function. In two cases of free muscle transfer for masseter substitution, electromyographic interpretations revealed full motor activity after bilateral latissimus dorsi transfer. Tongue neurotization was performed in two instances. Postoperatively, the patients' speech intelligibility improved as well as tongue motility and bulk.

Conclusion: The use of the C7 as a motor donor in Moebius cases with multicranial nerve involvement supplies the typical mask-like face with an abundance of motor fibers for facial reanimation and, if there is a coexisting twelfth nerve palsy, for speech restoration.


Norfolk, Va.

From the Microsurgical Research Center, Eastern Virginia Medical School, and the International Institute of Reconstructive Microsurgery.

Received for publication May 4, 2009; accepted December 29, 2009.

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

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Julia K. Terzis, M.D., Ph.D., Department of Surgery, Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School, 700 Olney Road, LH 2055, Norfolk, Va. 23501,

©2010American Society of Plastic Surgeons