One-stage reanimation of the paralyzed face using the rectus abdominis neurovascular free flap.

BACKGROUND: Functional free muscle transfer for the surgical correction of long-standing facial paralysis has gained validity over the past three decades. These traditionally multistep reconstructions often achieve clinical success, but at the cost of significant morbidity and lengthy recovery periods. To address this dilemma, the authors propose reconstruction using the rectus abdominis and accompanying intercostal nerve in a one-stage neurovascular free flap reanimation procedure. METHODS: Between 1998 and 2001, five patients with long-standing unilateral facial paralysis at the University of Pittsburgh Facial Nerve Center underwent reanimation using the authors' protocol. Preoperative and postoperative assessments included clinical evaluation using the Facial Grading System and electromyography. The patients were followed for a mean of 16 months. RESULTS: At the final postoperative visit, all five patients demonstrated improved levator electromyographic potential, with a median 67 percent improvement. All five patients further demonstrated an increase in zygomaticus electromyographic potential, with a median 225 percent improvement. All five patients demonstrated increased Facial Grading System score at most recent follow-up. CONCLUSIONS: The one-step reanimation using free rectus abdominis neurovascular free flap demonstrated a consistent positive outcome in electromyographic and clinical assessments. The additional benefits of reduced recovery time and anatomical reliability of the flap render the authors' method preferable to other traditional methods of surgical reanimation of the paralyzed face.

Muscle activity in the partially paralyzed face after placement of a fascial sling: a preliminary report.

Neuromuscular re-education (ie, physical therapy) is often the first treatment given to patients with a partial facial paralysis. The purpose of this paper was to examine whether by repositioning and supporting partially paretic muscles with a fascial sling, one could improve facial movement in patients for whom the benefits of physical therapy had plateaued. Six patients with a history of unilateral, partial facial paralysis were assessed using the Facial Grading System (FGS) and surface electromyography (EMG) recordings of facial muscle activity. Automated facial analysis (AFA) was used to measure the facial excursions of the most recent patient. The FGS composite scores indicated improvement following static sling placement in all patients. The FGS subscale scores for voluntary movement indicated that the excursion of facial movement increased in 4 of the 6 patients. Surface EMG data demonstrated increased muscle activity in the zygomaticus major muscle in all patients. AFA demonstrated that following sling placement, the excursion of the lip commissure nearly doubled. The sling procedure, traditionally considered an intervention for improving static symmetry of the face, may also be useful for enhancing movement in some patients with a partial facial paralysis. Additional data, such as measurements provided by AFA, are needed to correlate facial displacement with EMG muscle activity.