TY - JOUR
T1 - The degree of facial movement following microvascular muscle transfer in pediatric facial reanimation depends on donor motor nerve axonal density
AU - Snyder-Warwick, Alison K.
AU - Fattah, Adel Y.
AU - Zive, Leanne
AU - Halliday, William
AU - Borschel, Gregory H.
AU - Zuker, Ronald M.
N1 - Publisher Copyright:
Copyright © 2015 by the American Society of Plastic Surgeons.
PY - 2015
Y1 - 2015
N2 - Background: Free functional muscle transfer to the face is a standard of facial animation. The contralateral facial nerve, via a cross-face nerve graft, provides spontaneous innervation for the transferred muscle, but is not universally available and has additional shortcomings. The motor nerve to the masseter provides an alternative innervation source. In this study, the authors compared donor nerve histomorphometry and clinical outcomes in a single patient population undergoing free muscle transfer to the face. Methods: Pediatric patients undergoing dynamic facial (re-)animation with intraoperative nerve biopsies and gracilis transfer to the face powered by either the contralateral facial nerve via a cross-face nerve graft or the motor nerve to the masseter were reviewed over a 7-year period. Myelinated nerve counts were assessed histomorphometrically, and functional outcomes were evaluated with the Scaled Measurement of Improvement in Lip Excursion software. Results: From 2004 to 2011, 91 facial (re-)animation procedures satisfied study inclusion criteria. Average myelinated fiber counts were 6757 per mm2 in the donor facial nerve branch, 1647 per mm2 in the downstream cross-face nerve graft at the second stage, and 5289 per mm2 in the masseteric nerve. Reconstructions with either innervation source resulted in improvements in oral commissure excursion and smile symmetry, with the greatest amounts of oral commissure excursion noted in the masseteric nerve group. Conclusions: Facial (re-)animation procedures with use of the cross-face nerve graft or masseteric nerve are effective and result in symmetric smiles. The masseteric nerve provides a more robust innervation source and results in greater commissure excursion.
AB - Background: Free functional muscle transfer to the face is a standard of facial animation. The contralateral facial nerve, via a cross-face nerve graft, provides spontaneous innervation for the transferred muscle, but is not universally available and has additional shortcomings. The motor nerve to the masseter provides an alternative innervation source. In this study, the authors compared donor nerve histomorphometry and clinical outcomes in a single patient population undergoing free muscle transfer to the face. Methods: Pediatric patients undergoing dynamic facial (re-)animation with intraoperative nerve biopsies and gracilis transfer to the face powered by either the contralateral facial nerve via a cross-face nerve graft or the motor nerve to the masseter were reviewed over a 7-year period. Myelinated nerve counts were assessed histomorphometrically, and functional outcomes were evaluated with the Scaled Measurement of Improvement in Lip Excursion software. Results: From 2004 to 2011, 91 facial (re-)animation procedures satisfied study inclusion criteria. Average myelinated fiber counts were 6757 per mm2 in the donor facial nerve branch, 1647 per mm2 in the downstream cross-face nerve graft at the second stage, and 5289 per mm2 in the masseteric nerve. Reconstructions with either innervation source resulted in improvements in oral commissure excursion and smile symmetry, with the greatest amounts of oral commissure excursion noted in the masseteric nerve group. Conclusions: Facial (re-)animation procedures with use of the cross-face nerve graft or masseteric nerve are effective and result in symmetric smiles. The masseteric nerve provides a more robust innervation source and results in greater commissure excursion.
UR - http://www.scopus.com/inward/record.url?scp=84964307851&partnerID=8YFLogxK
U2 - 10.1097/PRS.0000000000000860
DO - 10.1097/PRS.0000000000000860
M3 - Article
C2 - 25626821
AN - SCOPUS:84964307851
SN - 0032-1052
VL - 135
SP - 370e-381e
JO - Plastic and reconstructive surgery
JF - Plastic and reconstructive surgery
IS - 2
ER -