The use of a double-powered free muscle transfer for facial reanimation has been reported by several authors with different types of nerve coaptation. A new nerve coaptation strategy is presented herein. We performed a 1-stage double-powered free gracilis muscle flap transfer in a patient with long-standing facial paralysis by splitting the obturator nerve and anastomosing the 2 free ends to the contralateral facial nerve (through a sural graft) and to the masseteric nerve. Voluntary movement of the transferred muscle with teeth clenching was observed at 6 months after the operation and a symmetric smile with bilateral elevation of the mouth angle at 10 months. Our limited experience suggests that in case of a large cross-section of the obturator nerve, the latter can be split and sutured to the ipsilateral masseteric nerve and to the contralateral facial nerve with a sural graft by double end-to-end anastomosis.
Obturator nerve split for gracilis free-flap double reinnervation in facial paralysis / Baccarani, A.; Starnoni, M.; Zaccaria, G.; Anesi, A.; Benanti, E.; Spaggiari, A.; De Santis, G.. - In: PLASTIC AND RECONSTRUCTIVE SURGERY – GLOBAL OPEN. - ISSN 2169-7574. - 7:6(2019), pp. e2106-e2109. [10.1097/GOX.0000000000002106]
Obturator nerve split for gracilis free-flap double reinnervation in facial paralysis
Baccarani A.;Starnoni M.;Anesi A.;Benanti E.;De Santis G.
2019
Abstract
The use of a double-powered free muscle transfer for facial reanimation has been reported by several authors with different types of nerve coaptation. A new nerve coaptation strategy is presented herein. We performed a 1-stage double-powered free gracilis muscle flap transfer in a patient with long-standing facial paralysis by splitting the obturator nerve and anastomosing the 2 free ends to the contralateral facial nerve (through a sural graft) and to the masseteric nerve. Voluntary movement of the transferred muscle with teeth clenching was observed at 6 months after the operation and a symmetric smile with bilateral elevation of the mouth angle at 10 months. Our limited experience suggests that in case of a large cross-section of the obturator nerve, the latter can be split and sutured to the ipsilateral masseteric nerve and to the contralateral facial nerve with a sural graft by double end-to-end anastomosis.File | Dimensione | Formato | |
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2019 Obturator_Nerve_Split_for_Gracilis_Free_flap.97902.pdf
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