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Neurotized Platysma Graft: A New Technique for Functional Reanimation of the Eye Sphincter in Longstanding Facial Paralysis

Nassif, Tomaz M.D.; Yung Chia, Chang M.D.

Plastic and Reconstructive Surgery: December 2019 - Volume 144 - Issue 6 - p 1061e-1070e
doi: 10.1097/PRS.0000000000006296
Reconstructive: Head and Neck: Original Articles

Background: In 1984, Terzis reported on the potential use of a free platysma muscle transfer to reanimate the orbicularis oculi in longstanding paralysis of this unit. However, the vascularized platysma flap proved difficult to transfer, and this technique is not widely used today. In the present study, the authors have described the technique involving grafting of the platysma muscle to restore eyelid function and retrospectively discussed its clinical outcomes.

Methods: This retrospective analysis included patients with longstanding facial paralysis who underwent orbicularis oculi reconstruction with neurotized platysma grafts. The authors have described the surgical technique and its retrospective clinical outcomes.

Results: Between 1992 and 2015, 38 consecutive patients underwent this procedure; of them, 34 [16 men (47 percent) and 18 women (53 percent)] completed the follow-up. The time between the first and second surgical stages was a mean 8.6 months (range, 6 to 22 months). The surgical results were good in 18 patients (53 percent) and the recovery was satisfactory in 13 (38 percent).

Conclusions: This study confirmed the feasibility and effectiveness of grafted muscle functional recovery and the efficiency of neuromuscular neurotization. The presented surgical technique is safe and effective for treating longstanding facial palsy of the orbicularis oculi muscle. This is the only technique that is easy and reproducible, leads to facial nerve recovery, and places a similar muscle at the original site of the paralyzed muscle for functional recovery.


Rio de Janeiro, Brazil

From the Department of Reconstructive Microsurgery, HSE; and the Clínica de Cirurgia Plástica Rio de Janeiro.

Received for publication September 5, 2018; accepted March 19, 2019.

Presented at the Fourth Congress of the World Society for Reconstructive Microsurgery, in Athens, Greece, June 22 through 27, 2007.

Disclosure:The authors have no financial interest to declare in relation to the content of this article. No funding was received for this study.

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Tomaz Nassif, M.D., Clínica de Cirurgia Plástica Rio de Janeiro, Rua General Garzon 22/303, Lagoa, Rio de Janeiro 22470-010, Brazil,

Copyright © 2019 by the American Society of Plastic Surgeons