Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 22:
Facial Paralysis
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  FIG. 22-35. First-stage reconstruction included dynamic McLaughlin temporalis transfer, dividing the coronoid process through the mouth. The coronoid has been drilled and threaded with a metal wire on a large needle to retain control of the coronoid during passage to the nasolabial incision. The anterior temporalis muscle was turned down and passed into the upper and lower lids.


FIG. 22-36. Eye closure is improved after first-stage reconstruction.


FIG. 22-37. Following second-stage reconstruction with dynamic serratus transplantation to the face. Smiling.


CASE 5

A 10-year-old girl has had post-traumatic incomplete right facial paralysis since the age of 3 months.

FIG. 22-38. At rest.


FIG. 22-39. Fortunately, there is good lid closure, but no lip action.


FIG. 22-40. Four-year follow-up. At rest.


FIG. 22-41. Smiling. Moderate lower lip lag remains.


CASE 6

  A 12-year-old boy had had left facial palsy since resection of a left parotid hemangioma at age 5 months.

FIG. 22-42. Previous facial-to-facial nerve grafting at age 2 had been unsuccessful because of atrophy of the facial muscle following nerve transection.


FIG. 22-43. Second-stage reconstruction with serratus transplantation. Muscle in place. We now orient the muscle much higher in the temporal area.


FIG. 22-44. Follow-up at 6 years. Now 18, the young man has a somewhat bulky muscle and the lip is down slightly at rest.


FIG. 22-45. Smiling.


References

1. Millesi, H.: Nerve suture and grafting to restore the extratemporal facial nerve. Clin. Plast. Surg. 6:333, 1979.

2. Bunnell, S.: Suture of the facial nerve within the temporal bone. Surg. Gyn. Obstet. 45:7, 1927.

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