Back to 2013 Annual Meeting Program
Experience of A One-stage Procedure by Using Spinal Accessory Nerve to Innervate a Functioning Free Muscle for Facial Paralysis
David Chwei-Chin Chuang, MD; Chang Gung Memorial Hospital
Department of Plastic Surgery, Chang Gung Memorial Hospital, Cha, Taipei-Linkou, Taiwan
Background: Functioning free muscle transplantation (FFMT) for facial paralysis has become a gold standard of surgical treatment for facial paralysis. However, one, two, or even more stage procedures and choice of the donor nerve have always been an area of great discussion and debate.
Methods: Since 2000, a total of 36 patients (11%) with 42 FFMTs were performed by using spinal accessory (XI) nerve transfer to innervate a transferred muscle for facial reanimation. Indications included bilateral or unilateral Möbius syndrome, contralateral facial nerve deficit, severe type of post-paretic facial synkinesis, and patient’s preference. Smile training is always required postoperatively to achieve spontaneous smile. A new grading system (tooth exposure score, 0-4), cortical adaptation stage (stage 0-V) and patient questionnaire were introduced for outcome assessment.
Results: Mean tooth excursion score improved from 0.5 preoperatively to 3.4 postoperatively. 96% showed good muscle movement with acceptable smile appearance. 84% presented with a cortical adaptation stage of at least III (independable movement) after a one year follow-up. Mean satisfaction score was 3 out of 5. 70% patients were scoring 3 or more.
Conclusion: The effectiveness of the new technique with a one stage procedure using XI nerve to innervate a FFMT for facial reanimation is decisive and encouraging.
Back to 2013 Annual Meeting Program