La réanimation faciale par deux nerfs en deux étapes: les résultats cliniques et les complications chez une série de patients pédiatriques

Translated title of the contribution: Two-Stage Dual-Nerve Facial Reanimation: Outcomes and Complications in a Series of Pediatric Patients

Molly M. McNeely, Fan Liang, Katelyn Makar, Christian J. Vercler, William Kuzon

Research output: Contribution to journalArticlepeer-review

Abstract

Background: In facial reanimation via microneurovascular muscle transfer, dual-nerve reinnervation of the muscle capitalizes on the synergistic effects of spontaneous motion from cross facial nerve grafting (CFNG) and increased excursion from masseteric nerve transfer. Two-stage approaches that delay masseteric nerve transfer until the time of the muscle flap increase spontaneity by maximizing muscle reinnervation from the CFNG. While this 2-stage, dual-nerve approach has been described in adults, we present a series of pediatric patients who underwent this reconstructive technique. Methods: We retrospectively reviewed all pediatric patients who underwent 2-stage, dual-nerve reconstruction with CFNG and ipsilateral masseteric nerve transfers. Procedures were performed between 2004 and 2016 by 2 surgeons at a single centre. Degree of facial paralysis before and after surgical intervention was measured using House-Brackmann scores. Results: Nine patients with a mean age of 8.6 (range: 5-15 years) years at time of surgery underwent 2-stage, dual-nerve reconstruction. Average time between CFNG and transfer of the free gracilis with masseteric nerve transfer was 13.3 (SD 2.4) months. Mean follow-up was 27.3 months (SD 25.7). Patients demonstrated initiation of voluntary movement on paralyzed side by 3.6 months (SD 0.6) on average, with 3 patients demonstrating spontaneous movement at 3 months. Conclusion: The 2-stage, dual innervation technique using CFNG and delayed ipsilateral masseteric nerve transfer with a free gracilis is a promising reconstructive option to maximize spontaneous expression in pediatric patients. Validated, objective scoring systems for excursion are needed before meaningful comparisons can be made to other reconstructive strategies.

Translated title of the contributionTwo-Stage Dual-Nerve Facial Reanimation: Outcomes and Complications in a Series of Pediatric Patients
Original languageFrench
Pages (from-to)280-286
Number of pages7
JournalPlastic Surgery
Volume29
Issue number4
DOIs
StatePublished - Nov 2021
Externally publishedYes

Keywords

  • dual nerve
  • facial
  • facial nerve
  • facial paralysis
  • pediatrics
  • reanimation
  • reconstructive surgery

ASJC Scopus subject areas

  • Surgery

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