Difficulty in Selecting the Motor Source in Dynamic Reconstruction with Latissimus Dorsi Myocutaneous Free Flap for Facial Nerve Palsy due to Möbius Syndrome

Abstract

Möbius syndrome, a congenital neurological disorder, is defined as the combination of bilateral facial nerve palsy and abducens nerve palsy that is congenital and nonprogressive. The etiology is unknown and it is thought that disturbances in the 7th and 8th cranial nerves are caused by abnormalities in brainstem genesis, brainstem ischemia in fetal life, or gene depletion. The degree of facial nerve palsy varies from plegia to paresis and the selection of motor source is the most difficult factor in dynamic reconstruction with neurovascular transfer of a myocutaneous free flap. We experienced a case in which we chose the hypoglossal nerve as the motor source in dynamic reconstruction with a myocutaneous free flap for facial nerve palsy due to Möbius syndrome. At 7 years of follow-up, symmetrical appearance of the face at rest with natural smiling was observed.