Revisional Operations Improve Results of Neurovascular Free Muscle Transfer for Treatment of Facial Paralysis

Abstract

Neurovascular free muscle transfer is currently the mainstay for smile reconstruction. However, problems such as excessive muscle bulk and dislocation of the transferred muscle attachment have been described. Furthermore, dynamic movements of the transferred muscle are sometimes too strong or too weak, resulting in facial asymmetry. In these cases, secondary revisional operations for the transferred muscle are required after neurovascular free muscle transfer. This report describes revisional operative procedures in detail and examines the extent of improvement of the smile by comparing preoperative and postoperative results. Of 468 patients in whom neurovascular free muscle transfer was performed between 1977 and 2000, a total of 183 received revisional operations for the transferred muscle. Operations included revision of muscle attachment in 129 patients, debulking of the cheek in 114 patients, and fascia graft in 21 patients. Evaluation with the grading scale was performed in 117 of the 183 patients. Grading improved in 59 patients and worsened in seven patients. The remaining 51 patients displayed no change in grading. Differences between preoperative and post-operative grading were compared statistically, and revisional operations improved the grading score. Revisional operations are effective and important as secondary operations after neurovascular free muscle transfer. However, care must be taken not to damage the neurovascular pedicles.