Blink Restoration in Long-standing Facial Paralysis: Use of Free Neurovascular Platysma Transfer

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Background:Since 2004, microneurovascular platysma transfer has been used for dynamic eye closure in long-standing facial palsy. The idea was initially presented by Lee and Terzis in 1984 but abandoned owing to its transfer difficulty. This muscle transfer allows forceful closure and blink restoration.Methods:This study included 24 patients operated between 2004 and 2014 for long-standing facial palsy. In the first step of the procedure, a cross-facial nerve graft was employed to transfer the motor nerve fibers from the normal side to the paralyzed side responsible for eye closure. Simultaneously, a dynamic reanimation of the mouth was conducted. After 9 months, a 4 × 9-cm platysma was transferred on its neurovascular pedicle. Revascularization was performed on the temporal vessels. Nerve coaptation between the cross-facial nerve graft and motor nerve of the platysma was also performed.Results:Twenty-one (88%) newly reconstructed orbicularis oculis displayed a good to excellent function. In 62% of the patients, a natural appearance and closure of the previously paralyzed eye and a return of spontaneous blinking were observed.Conclusions:Compared with classical techniques (eg, gold weight implantation and temporalis transfer), platysma transfer is the only feasible method of restoring eye closure because of its special architecture and fiber-type distribution.

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