OBJECTIVE To explore a new surgical approach to repair facial paralysis in late stage, using regional transposition of pedicled sternocleidomastoid muscle for the dynamic reanimation of the paralyzed face. METHODS Seven cases with facial paralysis in late stage from December 1999 were treated and followed up for 10 months before clinical evaluation. In all of the cases, the sternal and clavicular branches of the sternocleidomastoid muscle were both elevated from their bony attachments, with the mastoid insertion left in situ as the pedicle for blood supply and accessory nerve maintained in it. The muscle strips were transposed and sutured to the orbicularis oris around the mouth corner on the paralyzed side. RESULTS Static asymmetry of nose and oral commissure on the paralyzed side were corrected immediately after operation, and the movement of the oral commissure recovered one week after operation. Symmetric smiling was observed in one month and all of the oral movements recovered in 10 months postoperatively. CONCLUSION The new approach to repair facial paralysis in late stage by regional transposition of pedicled sternocleidomastoid muscle is effective in restoration of both static and dynamic symmetry of nose and mouth, and in recovery of the facial expression and the oral commissure.
Using transplantation of free muscle with microneurovascular anastomosis for 46 cases of late facial paralysis, we selected M. latissimus dorsi as neurovascularized muscle bundle graft in 28 of them. This was not only an operation for facial dynamic reconstruction but also a new method for reinnervation of oral and ocular sphincter. After operation all of them revealed symmetry with voluntary motions. The results were satisfactory. The indications for surgical treatment, the procedure, and the management after the treatment were discussed in details. The importance of reeducation of the regenerating nerve and the necessity of twostaged operation were also discussed.
On the basis of laboratory research of the reinnervation of poralyysed musele by implanting muscle bundies with neurovascular pedicle ( NVMBI),this method was applied clinically to trcat paralysed musele on extremities and trunks with quite satisfactory result.Detail description of preoperative exammation,operation design,surgical procedure and potoperative management were presented。the mechanism and reason of the good result were dscussed. The anatomical characteristics of the NVMBI we...