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David Chwei-chin Chuang - One of the best experts on this subject based on the ideXlab platform.
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Simultaneous Reconstruction of the Lower Lip with Gracilis Functioning Free Muscle Transplantation for Facial Reanimation: Comparison of Different Techniques.
Plastic and reconstructive surgery, 2018Co-Authors: Jerry Tsung-kai Lin, Tommy Nai-jen Chang, David Chwei-chin ChuangAbstract:BACKGROUND Functioning free Muscle Transplantation is currently the gold standard for the reconstruction of facial paralysis, focusing more on the upper lip reconstruction rather than on the lower lip. This study aimed to compare different lower lip reconstructive methods when performing functioning free Muscle Transplantation for facial reanimation. METHODS A retrospective review of functioning free Muscle Transplantation for facial reanimation from 2007 to 2015 was performed. Patients were divided into three groups: in group 1 (n = 15), a free plantaris tendon graft anchored to the gracilis Muscle was passed into the lower lip to create a loop within; in group 2 (n = 12), an aponeurosis tail of the gracilis Muscle was attached to the lower lip; and in group 3 (n = 18), no suspension of the lower lip was performed. All patients had at least 2 years of follow-up. Outcomes were assessed by photographs and videos, including subjective evaluation of midline deviation and horizontal tilt and objective analysis of smile dimensions and area. RESULTS A total of 45 patients were included. Results from the subjective evaluation demonstrate group 1 patients having the best improvement (overall score: p = 0.004 and p = 0.005, Fisher's exact test). The objective evaluation showed group 1 and 2 patients with better results compared with group 3 (horizontal component, p = 0.009; vertical component, p = 0.004; area distribution, p < 0.001, Kruskal-Wallis test). CONCLUSIONS Both plantaris tendon graft and gracilis aponeurosis achieved better improvement in subjective and objective evaluations than those who had no reconstruction of the lower lip. In particular, the plantaris tendon graft can achieve the most lower lip excursion with overall improved symmetry. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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cortical adaptation staging system a new and simple staging for result evaluation of functioning free Muscle Transplantation for facial reanimation
Annals of Plastic Surgery, 2014Co-Authors: Chiehhan John Tzou, David Chwei-chin Chuang, Hsinyu Sirena ChenAbstract:Background Movement-associated cortical reorganization occurs in patients after functioning free-Muscle Transplantation (FFMT), which is reinnervated by different neurotizers. Aiming to evaluate the process of recovery of the reinnervated Muscle, we defined the cortical reorganization into 5 stages. This staging system has been applied during the past 25 years at our center with great convenience and accessibility. Methods A standardized evaluation method for assessing the recovery after FFMT to reanimate the paralyzed face with at least a 1-year follow-up was applied. The evaluation included the following 5 stages: no movement, dependent movement, independent movement, and spontaneous movement with and without involuntary movement. Reliability of this technique was assessed by 3 examiners, who each evaluated the smiles of 30 unilateral facial paralysis patients 4 times, creating 360 sets of measurements. Results The intraclass correlation coefficients for interrater and intrarater reliability exceeded 0.929, which is considered excellent and reliable. Conclusions Chuang’s Cortical Adaptation Staging System is simple, quick, and accurate in evaluating patients after FFMT reanimation of the paralyzed face with no additional tools.
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The possibility and potential feasibility of putting an extra functioning free Muscle transplant onto a normal limb: experimental rat study.
Plastic and reconstructive surgery, 2011Co-Authors: David Chwei-chin Chuang, Kuang-te ChenAbstract:BACKGROUND Functioning free Muscle Transplantation is currently and popularly used clinically to restore motor deficit caused by traumatic Muscle loss or chronic Muscle denervation. However, no one uses functioning free Muscle Transplantation in a normal subject who has no motor deficit. This study was designed to investigate the possible and potential feasibility of transferring an extra free Muscle transplant onto a normal limb. METHODS A chimeric flap including biceps Muscle with its neurovascular pedicles and a skin perforator flap was designed, harvested, and transferred from a Lewis inbred rat to the other rat overlying the original biceps following neurovascular repair where the ulnar nerve was chosen as the neurotizer. Sixteen rats were operated on and evaluated 6 months after surgery. Outcome measurements included arm circumferences, electrophysiologic studies, elbow flexion force, and Muscle mass. The contralateral normal biceps was used as the control. RESULTS All outcome measurements revealed that the extra Muscle transfer resulted in significant increases in size and function of the operative limb without interfering with the original biceps function. CONCLUSION The authors' study demonstrates the possible and potential application of using extra free Muscle Transplantation for functional and aesthetic augmentation purposes in a normal subject.
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Brachial plexus injury: nerve reconstruction and functioning Muscle Transplantation.
Seminars in plastic surgery, 2010Co-Authors: David Chwei-chin ChuangAbstract:Adult brachial plexus injury remains a dilemma to a reconstructive microsurgeon, especially when attempting to reconstruct cases of total root avulsion. Different degrees and different levels of injury require different strategies of reconstruction. The purpose of this article is to illustrate the author's reconstructive strategy in correlation with the injury level of classification. Nerve transfer, functioning free Muscle Transplantation, and other palliative surgery are reconstructive options for level 1 injuries. Neurolysis, nerve repair, nerve grafts (free nerve graft or vascularized ulnar nerve graft), nerve transfer if associated with level 1 lesion in other spinal nerves, and palliative reconstruction are chosen options for level 2, 3, and 4 lesions. A clavicle osteotomy is often required in level 3 lesions. Nerve grafts are frequently applied in level 4 lesions, which result in less aberrant reinnervation and a better prognosis.
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Nerve Transfer with Functioning Free Muscle Transplantation
Hand clinics, 2008Co-Authors: David Chwei-chin ChuangAbstract:In this article, the author focuses on functioning free Muscle Transplantation (FFMT), an advanced microneurovascular technique indicated in patients who have an advanced injury with a major brachial Muscle or Muscle group loss or denervation and in whom no locally available or ideal musculotendinous donor unit exists. FFMTs have been successfully applied clinically in cases involving adult brachial plexus palsy, obstetric brachial plexus palsy, facial palsy, severe Volkmann's ischemia, and severe crushing and traction injuries of the forearm or arm with major Muscle loss. As the author notes, FFMT is a new challenge for the reconstructive surgeon. He outlines the eight major principles for nerve transfer with FFMT, basing his conclusions on the more than 333 patients who received FFMT between 1995 and 2005 in his hospital.
Manfred Frey - One of the best experts on this subject based on the ideXlab platform.
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The combination of Muscle transpositions and static procedures for reconstruction in the paralyzed face of the patient with limited life expectancy or who is not a candidate for free Muscle transfer.
Plastic and Reconstructive Surgery, 2009Co-Authors: Maria Michaelidou, Chiehhan John Tzou, Martina Mittlböck, Hans Gerber, Edgar Stussi, Manfred FreyAbstract:Background:In long-standing complete and irreversible facial palsy where reconstruction by nerve grafting alone is no longer sufficient, reconstruction by dynamic procedures such as Muscle Transplantation or Muscle transposition is required. The authors present the results obtained by regional muscl
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three dimensional video analysis of the paralyzed face reanimated by cross face nerve grafting and free gracilis Muscle Transplantation quantification of the functional outcome
Plastic and Reconstructive Surgery, 2008Co-Authors: Manfred Frey, Chiehhan John Tzou, Martina Mittlböck, Maria Michaelidou, Igor Pona, Hans Gerber, Edgar StussiAbstract:Background:Surgeons have found it difficult to quantify facial paralysis and its improvement by reconstructive surgery. This article presents the results achieved by free functional Muscle Transplantation for reconstruction of the paralyzed face, registered by three-dimensional video analysis of fac
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dynamic reconstruction of eye closure by Muscle transposition or functional Muscle Transplantation in facial palsy
Plastic and Reconstructive Surgery, 2004Co-Authors: Manfred Frey, Pietro Giovanoli, Chiehhan John Tzou, Nina Kropf, Susanne FriedlAbstract:For patients with facial palsy, lagophthalmus is often a more serious problem than the inability to smile. Dynamic reconstruction of eye closure by Muscle transposition or by free functional Muscle Transplantation offers a good solution for regaining near-normal eye protection without the need for implants. This is the first quantitative study of three-dimensional preoperative and postoperative lid movements in patients treated for facial paralysis. Between February of 1998 and April of 2002, 44 patients were treated for facial palsy, including reconstruction of eye closure. Temporalis Muscle transposition to the eye was used in 34 cases, and a regionally differentiated part of a free gracilis Muscle transplant after double cross-face nerve grafting was used in 10 cases. Patients' facial movements were documented by a three-dimensional video analysis system preoperatively and 6, 12, 18, and 24 months postoperatively. For this comparative study, only the data of patients with preoperative and 12-month postoperative measurements were included. In the 27 patients with a final result after temporalis Muscle transposition for eye closure, the distance between the upper and lower eyelid points during eye closing (as for sleep) was reduced from 10.33 ± 2.43 mm (mean ± SD) preoperatively to 5.84 ± 4.34 mm postoperatively on the paralyzed side, compared with 0.0 ± 0.0 mm preoperatively and postoperatively on the contralateral healthy side. In the resting position, preoperative values for the paralyzed side changed from 15.11 ± 1.92 mm preoperatively to 13.46 ± 1.94 mm postoperatively, compared with 12.17 ± 2.02 mm preoperatively and 12.05 ± 1.95 mm postoperatively on the healthy side. In the nine patients with a final result after surgery using a part of the free gracilis Muscle transplant reinnervated by a zygomatic branch of the contralateral healthy side through a cross-face nerve graft, eyelid closure changed from 10.21 ± 2.72 mm to 1.68 ± 1.35 mm, compared with 13.70 ± 1.56 mm to 6.63 ± 1.51 mm preoperatively. The average closure for the healthy side was from 11.20 ± 3.11 mm to 0.0 ± 0.0 mm preoperatively and from 12.70 ± 1.95 mm to 0.0 ± 0.0 mm postoperatively. In three cases, the resting tonus of the part of the gracilis Muscle transplant around the eye had increased to an extent that Muscle weakening became necessary. Temporalis Muscle transposition and free functional Muscle Transplantation for reanimation of the eye and mouth at the same time are reliable methods for reconstructing eye closure, with clinically adequate results. Detailed analysis of the resulting facial movements led to an important improvement of the authors' operative techniques within the last few years. Thus, the number of secondary operative corrections could be significantly reduced. These qualitative and quantitative studies of the reconstructed lid movements by three-dimensional video analysis support the authors' clinical concept of temporalis Muscle transposition being the first-choice method in adult patients with facial palsy. In children, free Muscle Transplantation is preferred for eye closure, so as not to interfere with the growth of the face by transposition of a masticatory Muscle. In addition, a higher degree of central plasticity in children might be expected.
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Limits of Muscle-to-nerve ratio in functional Muscle Transplantation.
Journal of reconstructive microsurgery, 2003Co-Authors: P. Giovanoli, Lars-peter Kamolz, Matthias Rab, Rupert Koller, Martina Mittlböck, Manfred FreyAbstract:The aim of the present study was to investigate the functional limits of over-dimensioning a free functioning Muscle transplant for neuromuscular reconstruction. A part of the rectus femoris Muscle, two and three times bigger than a scutuloauricularis Muscle, was used to functionally replace the latter after removal. The major finding of these experiments is that both double-sized and triple-sized portions of the rectus femoris Muscle developed maximal tetanic tensions during isometric contractions, which were up to 175 percent of the control scutuloauricularis Muscle of the unoperated, contralateral side, although the same branch of the facial nerve was used for reinnervation of the grafted Muscle. This implies that the supplying branch of the facial nerve has the potency to innervate a Muscle much larger than the originally supplied Muscle with optimal efficiency. These results underline the usefulness of overdimensioning during functional Muscle Transplantation, and also in limited neural capacity situations.
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Free Muscle Transplantation for treatment of facial palsy
European Journal of Plastic Surgery, 1991Co-Authors: Manfred Frey, Kiyonori Harii, L. Hakelius, D. Sing, Th. Stevenson, G. Freilinger, J.-p. A. Nicolai, Ch. SingsAbstract:Facial palsy is treated by many different operative procedures. In addition, factors such as the varying degree of paralysis, make postoperative comparisons difficult. The limited number of patients treated by free Muscle Transplantation at any one center also complicates evaluation of alternative treatments. This limitation has been overcome by development of an International Muscle Transplant Registry for collection, storage and analysis of data from different centers. As of June 1, 1988, 137 patients from 6 countries have been entered into the Registry. Significantly more USA/European patients had a congenital deficit and significantly more Japanese patients had a deficit resulting from surgery. According to a modification of the paresis scoring system proposed by Stennert et al. [3], USA/European patients also had a higher degree of nonsurgical facial paresis than Japanese patients. The most frequent preoperative treatment used in Japan was electrostimulation in 24% of cases, only 6% of European and American patients received this treatment. Evaluation of surgical procedures performed by the 2 groups of surgeons showed similar dimensions of Muscle grafts used in the face, with a length of about 8.5 cm and a width of 3.4 cm. The extensor digitorum brevis Muscle was the most popular, being used in 58% of European and American cases, whereas the Japanese choice was the gracilis Muscle in 94% of cases. The length of the nerve graft used by Japanese surgeons was 6 cm, longer than that used by European and American surgeons. At this time, these preliminary data suggest evidence for paresis improvement in 79% of patients overall. Ultimately, the Registry should permit evaluation of the efficacy of different operative techniques and should influence experimental research and clinical application of Muscle Transplantation.
Steven E R Hovius - One of the best experts on this subject based on the ideXlab platform.
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functional results after treatment of volkmann s ischemic contracture a long term followup study
Clinical Orthopaedics and Related Research, 2005Co-Authors: Jetske Ultee, Steven E R HoviusAbstract:The main objective of this retrospective study was to evaluate the long-term functional outcome in patients treated for Volkmann's ischemic contracture. In this study, functional outcome (measured as mobility, grip strength, and sensibility) and arm length difference after treatment of Volkmann's ischemic contracture were analyzed and discussed. Twenty-five patients treated between 1969 and 2001 were evaluated. The method of treatment was related to the severity of the infarction, ranging from conservative to free vascularized Muscle Transplantation. Although the study population was small, we could observe a wide range of functional outcome. Substantial improvement of function was obtained in patients who had free vascularized Muscle Transplantation. Unfortunately in one patient with an occlusion of the distal brachial artery and an insufficient flow through the collateral circulation of the radial artery, the gracilis Muscle was lost. Tendon lengthening had unsatisfactory results because of recurrence of the contracture. Excision of fibrotic Muscle tissue, neurolysis and tenolysis sometimes combined with a tendon transfer gave good hand function results in patients with sufficient remaining Muscle tissue. In most of the patients in whom the contracture developed during childhood, a difference in forearm length was observed.
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functional results after treatment of volkmann s ischemic contracture a long term followup study treatment of neglected trauma
Clinical Orthopaedics and Related Research, 2005Co-Authors: Jetske Ultee, Steven E R HoviusAbstract:The main objective of this retrospective study was to evaluate the long-term functional outcome in patients treated for Volkmann's ischemic contracture. In this study, functional outcome (measured as mobility, grip strength, and sensibility) and arm length difference after treatment of Volkmann's ischemic contracture were analyzed and discussed. Twenty-five patients treated between 1969 and 2001 were evaluated. The method of treatment was related to the severity of the infarction, ranging from conservative to free vascularized Muscle Transplantation. Although the study population was small, we could observe a wide range of functional outcome. Substantial improvement of function was obtained in patients who had free vascularized Muscle Transplantation. Unfortunately in one patient with an occlusion of the distal brachial artery and an insufficient flow through the collateral circulation of the radial artery, the gracilis Muscle was lost. Tendon lengthening had unsatisfactory results because of recurrence of the contracture. Excision of fibrotic Muscle tissue, neurolysis and tenolysis sometimes combined with a tendon transfer gave good hand function results in patients with sufficient remaining Muscle tissue. In most of the patients in whom the contracture developed during childhood, a difference in forearm length was observed.
Ralph T. Manktelow - One of the best experts on this subject based on the ideXlab platform.
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a comparison of commissure excursion following gracilis Muscle Transplantation for facial paralysis using a cross face nerve graft versus the motor nerve to the masseter nerve
Plastic and Reconstructive Surgery, 2006Co-Authors: Ronald M. Zuker, Ralph T. Manktelow, Shawna WadeAbstract:Background: The microneurovascular transfer of a free Muscle transplant is the procedure of choice for facial animation in a child with facial paralysis. One of the critical factors of this procedure is the selection of a motor nerve to innervate the transplanted Muscle. Methods: From 1989 to 1999, 166 free segmental gracilis Muscle transfers were performed in 121 children for facial animation. The cross-face nerve graft was used in 70 procedures (cross-face nerve graft group) to innervate the Muscle by branches of the seventh nerve for the normal side. The ipsilateral masseteric nerve was used in 94 procedures (50 patients, masseter group) and the ipsilateral accessory nerve was used in two procedures (one patient). To compare the operative procedures between the first two groups, all charts were reviewed. The extent of oral commissure movement was determined by measurements taken from the tragion to the oral commissure, both at rest and with full smile. In the cross-face nerve graft group (n = 20), the extents were measured on both the normal side and the reconstructed side; in the masseter group (n = 16), they were measured on the left and right sides. Results: No significant difference was found between the two groups (p < 0.05) for the mean age at the time of Muscle Transplantation, for the total operation time for Muscle Transplantation, and for the length of the Muscle used or for the fraction of circumference of the segment of gracilis Muscle used. Although the operative variables were similar between two groups, the Muscle excursion differed. Excursion in the cross-face nerve graft group was less than that on the right (p = 0.0006) or left (p = 0.0000) in the masseter group. Itwas also less than on the normal side (p = 0.0000) of the cross-face nerve graft group. Also, there was no significant difference between the left and right sides within the masseter group (p < 0.05). Furthermore, the extent of oral commissure movement in the masseter group was similar to that of the normal side in the cross-face nerve graft group (p = 0.35, p = 0.61). Conclusion: These results indicate that segmental gracilis Muscle Transplantation using the motor nerve to the masseter nerve for facial animation in children is a very reproducible operation and provides a commissure excursion in the range of normal.
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facial animation in children with mobius syndrome after segmental gracilis Muscle transplant
Plastic and Reconstructive Surgery, 2000Co-Authors: Ronald M. Zuker, Cory S Goldberg, Ralph T. ManktelowAbstract:Mobius syndrome is a complex congenital anomaly involving multiple cranial nerves, including the abducens (VI) and facial (VII) nerves, and often associated with limb anomalies. Muscle Transplantation has been used to address the lack of facial animation, lack of lower lip support, and speech difficulties these patients experience. The purpose of this study was to investigate the results of bilateral, segmental gracilis Muscle Transplantation to the face using the facial vessels for revascularization and the motor nerve to the masseter for reinnervation. The outcome of the two-stage procedure was assessed in 10 consecutive children with Mobius syndrome by direct interview, speech assessment, and oral commissure movement. Preoperative data were collected from direct questioning, viewing of preoperative videotapes, notes from prior medical evaluations, and rehabilitation medicine and speech pathology assessments. All of the patients developed reinnervation and Muscle movement. The children who described self-esteem to be an issue preoperatively reported a significant posttransplant improvement. The Muscle transplants produced a smile with an average commissure excursion of 1.37 cm. The frequency and severity of drooling and drinking difficulties decreased postoperatively in the seven symptomatic children. Speech difficulties improved in all children. Specifically, of the six children with bilabial incompetence, three received complete correction and three had significant improvement. Despite the length and complexity of these procedures, complications were minimal. Muscle Transplantation had positive effects in all problematic areas, with a high degree of patient satisfaction and improvement in drooling, drinking, speech, and facial animation. The surgical technique is described in detail and the advantages over regional Muscle transfers are outlined, Segmental gracilis Muscle Transplantation innervated by the motor nerve to the masseter is an effective method of treating patients with Mobius syndrome.
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The technique of Muscle Transplantation to the face in children with moebius syndrome
Operative Techniques in Plastic and Reconstructive Surgery, 1999Co-Authors: Ronald M. Zuker, Ralph T. ManktelowAbstract:Muscle Transplantation can not only provide vascularized cover, but when innervated by a functional motor nerve can lead to active and often quite dramatic movement. Its role in the facial paralysis of Moebius syndrome will be described.
Ronald M. Zuker - One of the best experts on this subject based on the ideXlab platform.
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a comparison of commissure excursion following gracilis Muscle Transplantation for facial paralysis using a cross face nerve graft versus the motor nerve to the masseter nerve
Plastic and Reconstructive Surgery, 2006Co-Authors: Ronald M. Zuker, Ralph T. Manktelow, Shawna WadeAbstract:Background: The microneurovascular transfer of a free Muscle transplant is the procedure of choice for facial animation in a child with facial paralysis. One of the critical factors of this procedure is the selection of a motor nerve to innervate the transplanted Muscle. Methods: From 1989 to 1999, 166 free segmental gracilis Muscle transfers were performed in 121 children for facial animation. The cross-face nerve graft was used in 70 procedures (cross-face nerve graft group) to innervate the Muscle by branches of the seventh nerve for the normal side. The ipsilateral masseteric nerve was used in 94 procedures (50 patients, masseter group) and the ipsilateral accessory nerve was used in two procedures (one patient). To compare the operative procedures between the first two groups, all charts were reviewed. The extent of oral commissure movement was determined by measurements taken from the tragion to the oral commissure, both at rest and with full smile. In the cross-face nerve graft group (n = 20), the extents were measured on both the normal side and the reconstructed side; in the masseter group (n = 16), they were measured on the left and right sides. Results: No significant difference was found between the two groups (p < 0.05) for the mean age at the time of Muscle Transplantation, for the total operation time for Muscle Transplantation, and for the length of the Muscle used or for the fraction of circumference of the segment of gracilis Muscle used. Although the operative variables were similar between two groups, the Muscle excursion differed. Excursion in the cross-face nerve graft group was less than that on the right (p = 0.0006) or left (p = 0.0000) in the masseter group. Itwas also less than on the normal side (p = 0.0000) of the cross-face nerve graft group. Also, there was no significant difference between the left and right sides within the masseter group (p < 0.05). Furthermore, the extent of oral commissure movement in the masseter group was similar to that of the normal side in the cross-face nerve graft group (p = 0.35, p = 0.61). Conclusion: These results indicate that segmental gracilis Muscle Transplantation using the motor nerve to the masseter nerve for facial animation in children is a very reproducible operation and provides a commissure excursion in the range of normal.
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facial animation in children with mobius syndrome after segmental gracilis Muscle transplant
Plastic and Reconstructive Surgery, 2000Co-Authors: Ronald M. Zuker, Cory S Goldberg, Ralph T. ManktelowAbstract:Mobius syndrome is a complex congenital anomaly involving multiple cranial nerves, including the abducens (VI) and facial (VII) nerves, and often associated with limb anomalies. Muscle Transplantation has been used to address the lack of facial animation, lack of lower lip support, and speech difficulties these patients experience. The purpose of this study was to investigate the results of bilateral, segmental gracilis Muscle Transplantation to the face using the facial vessels for revascularization and the motor nerve to the masseter for reinnervation. The outcome of the two-stage procedure was assessed in 10 consecutive children with Mobius syndrome by direct interview, speech assessment, and oral commissure movement. Preoperative data were collected from direct questioning, viewing of preoperative videotapes, notes from prior medical evaluations, and rehabilitation medicine and speech pathology assessments. All of the patients developed reinnervation and Muscle movement. The children who described self-esteem to be an issue preoperatively reported a significant posttransplant improvement. The Muscle transplants produced a smile with an average commissure excursion of 1.37 cm. The frequency and severity of drooling and drinking difficulties decreased postoperatively in the seven symptomatic children. Speech difficulties improved in all children. Specifically, of the six children with bilabial incompetence, three received complete correction and three had significant improvement. Despite the length and complexity of these procedures, complications were minimal. Muscle Transplantation had positive effects in all problematic areas, with a high degree of patient satisfaction and improvement in drooling, drinking, speech, and facial animation. The surgical technique is described in detail and the advantages over regional Muscle transfers are outlined, Segmental gracilis Muscle Transplantation innervated by the motor nerve to the masseter is an effective method of treating patients with Mobius syndrome.
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The technique of Muscle Transplantation to the face in children with moebius syndrome
Operative Techniques in Plastic and Reconstructive Surgery, 1999Co-Authors: Ronald M. Zuker, Ralph T. ManktelowAbstract:Muscle Transplantation can not only provide vascularized cover, but when innervated by a functional motor nerve can lead to active and often quite dramatic movement. Its role in the facial paralysis of Moebius syndrome will be described.
