The Combination of Muscle Transpositions and Static Procedures for Reconstruction in the Paralyzed Face of the Patient with Limited Life Expectancy or Who Is Not a Candidate for Free Muscle Transfer

Abstract

Background: In long-standing complete and irreversible facial palsy where reconstruction by nerve grafting alone is no longer sufficient, reconstruction by dynamic procedures such as muscle transplantation or muscle transposition is required. The authors present the results obtained by regional muscle transposition for reconstruction of eye closure and smile in patients with irreversible facial palsy. Methods: Twenty-nine patients treated by temporalis transposition for the eye and eight patients treated by masseter transposition for the mouth are presented. Assessment of outcome was based on clinical examination and analysis of facial movements by three-dimensional video analysis. Results: Preoperatively, the paretic eye fissure was on average 2.30 ± 2.17 mm wider than the healthy one. The difference was reduced postoperatively to 0.95 ± 1.89 mm. Paralytic lagophthalmus during closure of the eyes was 9.59 ± 3.03 mm preoperatively and was reduced postoperatively to 4.33 ± 2.68 mm. Ocular tearing and desiccation were reduced drastically in all patients. Static asymmetry of the mouth corner improved from 14.17 ± 5.26 mm preoperatively to 5.38 ± 3.23 mm postoperatively. The index of dynamic symmetry improved from −0.17 ± 0.25 preoperatively to 0.18 ± 0.19 postoperatively. This means that, postoperatively, the amplitude of motion on the reconstructed side reached 18 ± 19 percent that of the amplitude on the healthy side, whereas preoperatively a shift of the paralyzed mouth corner toward the healthy side occurred. Conclusions: Muscle transposition improves static symmetry and provides dynamic activity to a certain degree. It is therefore a valuable concept for patients with limited life expectancy.