Abstract
We perform neurovascular free muscle transfer for smile reconstruction in the treatment of established facial paralysis. Some surgical methods have previously been reported for neurovascular free muscle transfer, but we describe herein a one-stage latissimus dorsi muscle transplantation.
The aim of reconstruction by neurovascular free muscle transfer is that the paralyzed side will achieve dynamic movement synchronized with the non-paralyzed side of the face. To achieve this aim: 1) the transferred muscle must contract smoothly and sufficiently; and 2) movement of the transferred muscle must reflect the formation of an expression well. To achieve the former goal, we perform rehabilitation for two years postoperatively. In particular it is important that the patient performs rehabilitation using a mirror in order to receive visual feedback while making an expression. To achieve the latter goal, we perform revisional surgery for problems with the neurovascular free muscle transfer arising more than two years postoperatively.
Neurovascular free muscle transfer is now a standard procedure for dynamic smile reconstruction in patients with established facial paralysis. As postoperative treatment, it is important to perform rehabilitation for two years postoperatively. Furthermore, a revisional operation is effective. Good results have been obtained by treatment based on “ total facial reconstruction ”.
