Facial paralysis and the role of free muscle transplantation

Facial paralysis can have significant functional, psychological and aesthetic concerns that alter the lives of our patients. These effects can be functional, affecting the eye, nose and mouth, or aesthetic, affecting the symmetry of the face and particularly the mimetic function of smile. Several reanimation procedures have been described to address this. In this chapter, we will outline our technique for reanimation utilizing segmental gracilis muscle transplants to the face. These are innervated either by the contralateral normal 7th nerve via a cross face nerve graft, or a different ipsilateral motor where no 7th nerve is available or would not produce the required result. The other ipsilateral motor that we have found extremely effective is the motor nerve to masseter. This can power a segmental gracilis muscle transplant and lead to excursion that is near normal. These techniques will be described in detail.