Combination Treatment with Depressor Anguli Oris Myectomy and Pedicled Buccal Fat Pad Flap for Sequelae of Facial Paralysis: Case Reports

Abstract

Facial paralysis sequelae result in functional and cosmetic deficits. Myectomy for facial contractures has been reported, and recently, selective myectomy of the smile antagonists (depressor anguli oris [DAO]) for perioral synkinesis has gained attention. Although less invasive, this approach can lead to postoperative depressed deformities of the myectomy site. We report two cases of facial nerve paralysis. In one case, DAO myectomy was performed for synkinesis with the upper lip levator muscles. In the other, the DAO and depressor labii inferioris were myectomized for facial contractures centered on the lower lip. A pedicled buccal fat pad flap was elevated to cover the myectomy defect, preventing postoperative depressed deformity. One year postoperatively, no depressed deformities were observed; lower lip symmetry and oral commissure movement improved, achieving a natural smile. As the procedure involves the transfer of vascularized blood-rich buccal fat, the risk of postoperative induration and contracture is lower than that with fat injections.

Keywords

selective myectomy - depressor anguli oris - depressor labii inferioris - pedicled buccal fat pad flap

Authors' Contributions

Conceptualization: K.N. Data curation: H.S. Formal analysis: H.S. Methodology: S.K., H.S., E.M. Visualization: K.N., H.S. Writing—original draft: K.N. Writing—review and editing: H.S., E.M.

Ethical Approval

This study was conducted in accordance with the principles of the Declaration of Helsinki.

Patient Consent

Written informed consent was obtained from both patients for publication of this case report and accompanying images and video.

Publikationsverlauf

Eingereicht: 30. September 2024

Angenommen: 07. Mai 2025

Accepted Manuscript online:
10. Juni 2025

Artikel online veröffentlicht:
01. September 2025

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