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Orthodromic Temporalis Flap and End-to-Side Cross Face Nerve Grafts for Facial Reanimation
Fausto Viterbo, PhD; Adriana Romao
Sao Paulo State University, Botucatu, Brazil
Introduction: Individuals with facial paralysis of 6 or more months’ duration without evidence of clinical or electromyographic improvement have been successfully reanimated utilizing an orthodromic temporalis transfer in conjunction with end-to-side cross face nerve grafts. The temporalis muscle insertion is released from the coronoid process of the mandible and sutured to a fascia lata graft. The other extremity is suture to the modiulos and lower and upper paralyzed hemi lip. The muscle flap is combined with sural cross face nerve grafts with end-to-side neurorrhaphies connecting right and left buccal brunches. Cross face nerve grafting provides the potential for true spontaneous facial motion. The synergy created by the combination of techniques has produced a more symmetrical and synchronized smile than either procedure in isolation.
Methods: 19 patients underwent an orthodromic temporal muscle flap in conjunction with cross face (buccal-buccal with end-to-side neurorrhaphy) nerve grafts. To evaluate the symmetry of the smile we measured the length of the two hemilips (normal and affected) using the CorelDRAW X3 software. Measurements were obtained in both the pre and postoperative period and compared for symmetry. RESULTS: 89.5% of patients showed significant improvement in smile symmetry. CONCLUSION: Orthodromic temporalis muscle transfer in conjunction with cross face nerve grafts creates a synergistic effect frequently producing an aesthetic, symmetric smile.
Key-words: orthodromic; end-to-side; nerve grafts; facial reanimation
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