Arch Plast Surg.  2021 May;48(3):282-286. 10.5999/aps.2020.01599.

Dual-innervated multivector muscle transfer using two superficial subslips of the serratus anterior muscle for long-standing facial paralysis

Affiliations
  • 1Department of Plastic and Reconstructive Surgery, Ichikawa General Hospital, Tokyo Dental College, Ichikawa, Japan
  • 2Department of Plastic and Reconstructive Surgery, Yokohama Municipal Citizen’s Hospital, Yokohama, Japan
  • 3Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan

Abstract

Recent reports have described several cases of double muscle transfers to restore natural, symmetrical smiles in patients with long-standing facial paralysis. However, these complex procedures sometimes result in cheek bulkiness owing to the double muscle transfer. We present the case of a 67-year-old woman with long-standing facial paralysis, who underwent two-stage facial reanimation using two superficial subslips of the serratus anterior muscle innervated by the masseteric and contralateral facial nerves via a sural nerve graft. Each muscle subslip was transferred to the upper lip and oral commissures, which were oriented in different directions. Furthermore, a horizontal fascia lata graft was added at the lower lip to prevent deformities such as lower lip elongation and deviation. Voluntary contraction was noted at roughly 4 months, and a spontaneous smile without biting was noted 8 months postoperatively. At 18 months after surgery, the patient demonstrated a spontaneous symmetrical smile with adequate excursion of the lower lip, upper lip, and oral commissure, without cheek bulkiness. Dual-innervated muscle transfer using two multivector superficial subslips of the serratus anterior muscle may be a good option for long-standing facial paralysis, as it can achieve a symmetrical smile that can be performed voluntarily and spontaneously.

Keyword

Facial paralysis / Free tissue flap / Serratus anterior muscle
Full Text Links
  • APS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr