Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Dual-innervated multivector muscle transfer using two superficial subslips of the serratus anterior muscle for long-standing facial paralysis

  • Sakuma, Hisashi (Department of Plastic and Reconstructive Surgery, Ichikawa General Hospital, Tokyo Dental College) ;
  • Tanaka, Ichiro (Department of Plastic and Reconstructive Surgery, Ichikawa General Hospital, Tokyo Dental College) ;
  • Yazawa, Masaki (Department of Plastic and Reconstructive Surgery, Keio University School of Medicine) ;
  • Oh, Anna (Department of Plastic and Reconstructive Surgery, Keio University School of Medicine)
  • Received : 2020.08.11
  • Accepted : 2020.11.03
  • Published : 2021.05.15
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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.

Keywords

Acknowledgement

This work was supported by JSPS KAKENHI (Grant No. JP 20K18443).

References

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