The Dynamic Lip Reconstruction with Variable Free Neuromuscular Transfers in Chronic Facial Palsy

ABSTRACT

The goals of ideal lip reconstruction in chronic facial palsy include recovery of sphincteric function of the lip and symmetry of mouth during facial expression and the resting state. The lip reconstruction in chronic facial palsy can be mainly divided into dynamic and static method. Recently, the dynamic lip reconstruction tend to be reported more frequently with the development of microsurgery. From December of 1994 to August of 2001, We had 6 dynamic lip reconstruction by one or two staged free neurovascular flap, and followed up from 1 to 4 years and 4 months (mean 36 months). One case was two-staged free rectus abdominis flap after cross-face nerve graft with sural nerve. Another case was one- staged free gracilis muscle flap anastmosised with one of the buccal branch of facial nerve in the affected side, which had relatively good function. The other 4 cases were one-staged free neurovascular latissimus dorsi flaps. We also combined other procedures such as gold implant for lagophthalmos, temporalis muscle transfer on ectropion of the lower eyelid, and the excisional eyebrow lift on the affected side. We got relatively satisfactory results except 1 case.