Used when first two options unavailable, or when significant muscle atrophy has occurred (i.e., complete paralysis for two years or more)
Used for sagging/paralyzed oral commissure
Requires intact CN V
Provides posterior pull on midface
Cannot be used for orbital rehabilitation
Muscle divided into four slips
Superior pull preferred to masseteric vector
debilitated patients with poor prognosis
Lack of nerve/muscle availability
Adjunct to dynamic procedure
immediate restoration of symmetry
Improvement in oral competence, nasal obstruction
Harii et al. One-Stage Transfer of the Latissimus Dorsi Muscle for Reanimation of a Paralyzed Face: A New Alternative.
One-stage microvascular free transfer of the latissimus dorsi muscle for long-standing unilateral facial n. paralysis
Thoracodorsal nerve is crossed through the upper lip and sutured to the contralateral intact facial nerve branches.
Reinnervation of the transferred muscle is established at a mean of 7 months postoperatively, which is faster than that of the two-stage method.
24 patients, 21 patients (more than 87 percent) believed that their results were excellent or satisfactory, which also compares well with the results of the two-stage method combining free-muscle transfer with cross-face nerve graft.
Cronin et al. The effectiveness of neuromuscular facial retraining combined with electromyography in facial paralysis rehabilitation
The study goal was to present the effectiveness of neuromuscular facial retraining techniques used in combination with electromyography forimproving facial function even in cases of longstanding paralysis.
Study design and setting
We conducted a retrospective case review in a tertiary neurotology clinic.
Twenty-four patients with facial paralysis received neuromuscular facial retraining between April 1999 and April 2001. The patient sample included 6 males and 18 females, with an average age of 44 years. A control group consisted of 6 patients (4 females and 2 males).
All patient groups made significant improvements in function with improved symmetry in dual-channel electromyographic readings and increased facial movement percentages. Some of the percentages of posttreatment facial function were as follows: acoustic neuromas, 93%; Bell’s palsy/Ramsay Hunt syndrome, 80%; and facial nerve anastomosis, 71%. Synkinesis was reduced by at least 2 levels in patients who initially demonstrated synkinesis.
Neuromuscular facial retraining exercises and electromyography are effective for improving facial movements.