Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Combination Treatment with Depressor Anguli Oris Myectomy and Pedicled Buccal Fat Pad Flap for Sequelae of Facial Paralysis: Case Reports

  • Ko Nakao (Department of Plastic and Reconstructive Surgery, Ichikawa General Hospital, Tokyo Dental College) ;
  • Eri Matoba (Department of Plastic and Reconstructive Surgery, Ichikawa General Hospital, Tokyo Dental College) ;
  • Hisashi Sakuma (Department of Plastic and Reconstructive Surgery, Ichikawa General Hospital, Tokyo Dental College)
  • Received : 2024.09.30
  • Accepted : 2025.05.07
  • Published : 2025.09.15
Download PDF
⟨ Previous Next ⟩

Abstract

Facial paralysis sequelae result in functional and cosmetic deficits. Myectomy for facial contractures has been reported, and recently, selective myectomy of the smile antagonists (depressor anguli oris [DAO]) for perioral synkinesis has gained attention. Although less invasive, this approach can lead to postoperative depressed deformities of the myectomy site. We report two cases of facial nerve paralysis. In one case, DAO myectomy was performed for synkinesis with the upper lip levator muscles. In the other, the DAO and depressor labii inferioris were myectomized for facial contractures centered on the lower lip. A pedicled buccal fat pad flap was elevated to cover the myectomy defect, preventing postoperative depressed deformity. One year postoperatively, no depressed deformities were observed; lower lip symmetry and oral commissure movement improved, achieving a natural smile. As the procedure involves the transfer of vascularized blood-rich buccal fat, the risk of postoperative induration and contracture is lower than that with fat injections.

Keywords

Acknowledgement

We gratefully acknowledge the work of the members of the Department of Surgery at Ichikawa General Hospital. We would also like to thank Editage for the English editing and proofreading services.

References

  1. Gillum WN, Anderson RL. Blepharospasm surgery. An anatomical approach. Arch Ophthalmol 1981;99(06):1056–1062
  2. Azizzadeh B, Irvine LE, Diels J, et al. Modified selective neurectomy for the treatment of post-facial paralysis synkinesis. Plast Reconstr Surg 2019;143(05):1483–1496
  3. Leader B, Griffin GR, Larian B, et al. End-to-trunk masseteric to facial nerve transfer with selective neurectomy for facial reanimation. J Craniofac Surg 2021;32(08):2864–2866
  4. Sanchez CV, Gault NA, Gopalan TA, Rozen SM. Selective myectomies alone versus selective myectomies combined with neurectomies in postparetic synkinesis: comparing outcomes. Plast Reconstr Surg 2024;154(04):859–869
  5. O'Rourke SP, Miller MQ. Predicting depressor anguli oris excision outcomes using local muscle block. Facial Plast Surg Aesthet Med 2023;25(04):325–331
  6. Ryu MH, Kahng D, Shin Y. Surgical correction of crow's feet deformity with radiofrequency current. Aesthet Surg J 2014;34 (01):28–33
  7. Viterbo F, Lutz BS. Extended "C" myectomy of the lateral orbicularis oculi muscle-A safe and successful method for treatment of "crow's feet". Aesthet Surg J 2006;26(02):131–135
  8. Huang W, Ye HS, Tan JW, Huang S. Application of the buccal fat pad in oral reconstruction: covered with collagen membrane or not? J Craniofac Surg 2022;33(06):e559–e562
  9. Hanazawa Y, Itoh K, Mabashi T, Sato K. Closure of oroantral communications using a pedicled buccal fat pad graft. J Oral Maxillofac Surg 1995;53(07):771–775, discussion 775–776
  10. Rácz L, Maros TN, Seres-Sturm L. Structural characteristics and functional significance of the buccal fat pad (corpus adiposum buccae). Morphol Embryol (Bucur) 1989;35(02):73–77
  11. Udagawa A, Arikawa K, Shimizu S, et al. A simple reconstruction for congenital unilateral lower lip palsy. Plast Reconstr Surg 2007; 120(01):238–244
  12. Shtraks JP, Mirocha J, Azizzadeh B. Quality of life outcomes after modified selective neurectomy for postfacial paralysis synkinesis. Facial Plast Surg Aesthet Med 2021;23(06):443–448
  13. Yoshioka N, Yamanaka H, Morimoto N. Selective orbicularis neuromyectomy: a reliable treatment for periocular synkinesis. J Plast Reconstr Surg 2022;2(02):37–41
  14. Viterbo F, Joethy J, Brock RS. Aesthetic and non-aesthetic indications for orbicularis oculi myectomy. Aesthetic Plast Surg 2016;40 (04):466–474
  15. Chien CY, Hwang CF, Chuang HC, Jeng SF, Su CY. Comparison of radial forearm free flap, pedicled buccal fat pad flap and splitthickness skin graft in reconstruction of buccal mucosal defect. Oral Oncol 2005;41(07):694–697
  16. Baumann A, Ewers R. Application of the buccal fat pad in oral reconstruction. J Oral Maxillofac Surg 2000;58(04):389–392, discussion 392–393
  17. Vejbrink Kildal V, Jensson D, Weninger WJ, Meng S, Tzou CJ, Rodriguez-Lorenzo A. Anatomical features in lower-lip depressor muscles for optimization of myectomies in marginal mandibular nerve palsy. J Craniofac Surg 2021;32(06):2230–2232
  18. Curtin JW, Greeley PW, Gleason M, Braver D. A supplementary procedure for the improvement of facial nerve paralysis. Plast Reconstr Surg Transplant Bull 1960;26:73–79
  19. Volk GF, Pohlmann M, Sauer M, Finkensieper M, GuntinasLichius O. Quantitative ultrasonography of facial muscles in patients with chronic facial palsy. Muscle Nerve 2014;50(03): 358–365
  20. Hussain G, Manktelow RT, Tomat LR. Depressor labii inferioris resection: an effective treatment for marginal mandibular nerve paralysis. Br J Plast Surg 2004;57(06):502–510