Bidirectional/double fascia grafting for simple and semi-dynamic reconstruction of lower lip deformity in facial paralysis

Abstract

For the total aesthetic reconstruction of facial paralysis, treatment of lower lip deformity as "a neglected target in facial reanimation" is important. Although various dynamic reconstruction approaches have been reported for lower lip deformity, these have not been popularly performed due to aggressive surgical invasiveness, long recovery time for reinnervation, and unstable outcomes. To reconstruct the lower lip deformity more simply but semi-dynamically, we modified bidirectional/double fascia grafting methods that have been established as simple and minimally invasive treatments for pediatric congenital lower lip paralysis. Between 2009 and 2011, nine patients were treated using this procedure alone or with combinations of other procedures of facial reanimation such as one-stage free muscle transfer. For outcome assessment, patients were evaluated using a lower lip paralysis grading system, including the objective aesthetics and functional results of the lower lip at rest (score range, 0-1), during smiling (score range, 0-4), and during mouth opening (score range, 0-2). The mean total scores improved from 1.43 (poor) preoperatively to 5.71 (excellent) postoperatively. In all evaluation items, the postoperative scores improved significantly compared to the preoperative scores (p<0.01) with no severe complications. The procedure is simply applied to various types of extensive facial paralysis, as well as congenital lower lip paralysis in combination with other static and dynamic reconstruction methods for facial paralysis, and it is suggested that this approach significantly and semi-dynamically improves the aesthetic function of the lower lip at rest, during smiling, and during mouth opening.