J Reconstr Microsurg 2009; 25(8): 457-463
DOI: 10.1055/s-0029-1223851
© Thieme Medical Publishers

The Phrenic Nerve as a Motor Nerve Donor for Facial Reanimation with the Free Latissimus Dorsi Muscle

Yang-Bin Xu1 , Junchi Liu1 , Ping Li1 , Matthias B. Donelan2 , Brian M. Parrett2 , Jonathan M. Winograd2
  • 1Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P.R. China
  • 2Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
Further Information

Publication History

Publication Date:
21 August 2009 (online)

ABSTRACT

Free functional muscle transfer for acquired facial paralysis most often involves two stages. In this report, we describe single-stage free muscle transfer using the phrenic nerve as the donor motor nerve. Six patients with unilateral facial paralysis underwent single-stage facial reanimation using a free latissimus dorsi muscle with the ipsilateral phrenic nerve as the donor nerve. These cases were retrospectively studied to review technique and to determine outcomes including time to muscle reinnervation, patient satisfaction, smile symmetry, and complications. The mean age was 33 years. Five patients had complete unilateral facial paralysis and one had incomplete. There was no flap loss. The transferred muscle demonstrated active contraction in all patients at a mean of 14 weeks postoperatively (range, 12 to 16 weeks). Good dynamic symmetry was achieved by 6 to 9 months in all patients. All patients underwent rehabilitation including nerve reeducation. No clinically significant pulmonary morbidity was observed after the unilateral transection of the phrenic nerve. Using the phrenic nerve in free muscle transfer for facial paralysis allows a single-stage procedure with no requirement for nerve grafting and a rapid reinnervation time, shortening the time required for restoring facial animation.

REFERENCES

  • 1 Harii K, Ohmori K, Torii S. Free gracilis muscle transplantation, with microneurovascular anastomoses for the treatment of facial paralysis. A preliminary report.  Plast Reconstr Surg. 1976;  57 133-143
  • 2 O'Brien B M, Pederson W C, Khazanchi R K, Morrison W A, MacLeod A M, Kumar V. Results of management of facial palsy with microvascular free-muscle transfer.  Plast Reconstr Surg. 1990;  86 12-22 discussion 23-24
  • 3 Manktelow R T. Free muscle transplantation for facial paralysis.  Clin Plast Surg. 1984;  11 215-220
  • 4 Terzis J K, Noah M E. Analysis of 100 cases of free-muscle transplantation for facial paralysis.  Plast Reconstr Surg. 1997;  99 1905-1921
  • 5 Lifchez S D, Sanger J R, Godat D M, Recinos R F, LoGiudice J A, Yan J G. The serratus anterior subslip: anatomy and implications for facial and hand reanimation.  Plast Reconstr Surg. 2004;  114 1068-1076
  • 6 Terzis J K. Pectoralis minor: a unique muscle for correction of facial palsy.  Plast Reconstr Surg. 1989;  83 767-776
  • 7 Hata Y, Yano K, Matsuka K, Ito O, Matsuda H, Hosokawa K. Treatment of chronic facial palsy by transplantation of the neurovascularized free rectus abdominis muscle.  Plast Reconstr Surg. 1990;  86 1178-1187 discussion 1188-1189
  • 8 Jiang H, Guo E T, Ji Z L, Zhang M L, Lu V. One-stage microneurovascular free abductor hallucis muscle transplantation for reanimation of facial paralysis.  Plast Reconstr Surg. 1995;  96 78-85
  • 9 Ueda K, Harii K, Yamada A. Free neurovascular muscle transplantation for the treatment of facial paralysis using the hypoglossal nerve as a recipient motor source.  Plast Reconstr Surg. 1994;  94 808-817
  • 10 van de Graaf R C, IJpma F F, Nicolai J P. Facial reanimation by means of the hypoglossal nerve: anatomic comparison of different techniques.  Neurosurgery. 2008;  63 E820
  • 11 Lifchez S D, Matloub H S, Gosain A K. Cortical adaptation to restoration of smiling after free muscle transfer innervated by the nerve to the masseter.  Plast Reconstr Surg. 2005;  115 1472-1479 discussion 1480-1482
  • 12 Manktelow R T, Tomat L R, Zuker R M, Chang M. Smile reconstruction in adults with free muscle transfer innervated by the masseter motor nerve: effectiveness and cerebral adaptation.  Plast Reconstr Surg. 2006;  118 885-899
  • 13 Faria J C, Scopel G P, Busnardo F F, Ferreira M C. Nerve sources for facial reanimation with muscle transplant in patients with unilateral facial palsy: clinical analysis of 3 techniques.  Ann Plast Surg. 2007;  59 87-91
  • 14 Kumar P A, Hassan K M. Cross-face nerve graft with free-muscle transfer for reanimation of the paralyzed face: a comparative study of the single-stage and two-stage procedures.  Plast Reconstr Surg. 2002;  109 451-462 discussion 463-464
  • 15 Sassoon E M, Poole M D, Rushworth G. Reanimation for facial palsy using gracilis muscle grafts.  Br J Plast Surg. 1991;  44 195-200
  • 16 Terzis J, Faibisoff B, Williams B. The nerve gap: suture under tension vs. graft.  Plast Reconstr Surg. 1975;  56 166-170
  • 17 Wei W, Zuoliang Q, Xiaoxi L et al.. Free split and segmental latissimus dorsi muscle transfer in one stage for facial reanimation.  Plast Reconstr Surg. 1999;  103 473-480 discussion 481-482
  • 18 Harii K, Asato H, Yoshimura K, Sugawara Y, Nakatsuka T, Ueda K. One-stage transfer of the latissimus dorsi muscle for reanimation of a paralyzed face: a new alternative.  Plast Reconstr Surg. 1998;  102 941-951
  • 19 Gu Y D, Ma M K. Use of the phrenic nerve for brachial plexus reconstruction.  Clin Orthop Relat Res. 1996;  323 119-121
  • 20 Wood M B, Murray P M. Heterotopic nerve transfers: recent trends with expanding indication.  J Hand Surg [Am]. 2007;  32 397-408
  • 21 Spector J G. Mimetic surgery for the paralyzed face.  Laryngoscope. 1985;  95 1494-1522
  • 22 Luedemann W, Hamm M, Blömer U, Samii M, Tatagiba M. Brachial plexus neurotization with donor phrenic nerves and its effect on pulmonary function.  J Neurosurg. 2002;  96 523-526
  • 23 Chuang D C, Lee G W, Hashem F, Wei F C. Restoration of shoulder abduction by nerve transfer in avulsed brachial plexus injury: evaluation of 99 patients with various nerve transfers.  Plast Reconstr Surg. 1995;  96 122-128
  • 24 Chuang M L, Chuang D C, Lin I F, Vintch J R, Ker J J, Tsao T C. Ventilation and exercise performance after phrenic nerve and multiple intercostal nerve transfers for avulsed brachial plexus injury.  Chest. 2005;  128 3434-3439
  • 25 Xu W D, Gu Y D, Lu J B, Yu C, Zhang C G, Xu J G. Pulmonary function after complete unilateral phrenic nerve transection.  J Neurosurg. 2005;  103 464-467
  • 26 Yang Y, Chen L, Gu Y D, Hu S N, Zhang H. [Long-term impact of transfer of phrenic nerve on respiratory system of children: a clinical study of 34 cases].  Zhonghua Yi Xue Za Zhi. 2006;  86 1179-1182
  • 27 Koshima I, Tsuda K, Hamanaka T, Moriguchi T. One-stage reconstruction of established facial paralysis using a rectus abdominis muscle transfer.  Plast Reconstr Surg. 1997;  99 234-238
  • 28 Berges C, Boutault F, Fraysse B. Rehabilitation of long-term facial paralysis.  Rev Laryngol Otol Rhinol (Bord). 1995;  116 41-43
  • 29 Vanswearingen J. Facial rehabilitation: a neuromuscular reeducation, patient-centered approach.  Facial Plast Surg. 2008;  24 250-259

Jonathan M WinogradM.D. 

Massachusetts General Hospital, 15 Parkman Street

Wang 435, Boston, MA 02114

Email: jwinograd@partners.org

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