A Single Motor Donor Nerve for Two Functional Free Flaps in Facial Reanimation.

Area of Science:

• Plastic and reconstructive surgery
• Pediatric neurosurgery
• Craniofacial microsurgery

Background:

• Bilateral facial palsy poses significant reconstructive challenges, impacting facial aesthetics and function.
• Pediatric cases often require tailored surgical approaches due to unique anatomical and physiological considerations.
• Tumor excision, particularly for cerebellar tumors like pilocytic astrocytoma, can lead to complex cranial nerve deficits.

Observation:

• A 9-year-old patient presented with bilateral facial palsy, abducens nerve palsy, and left masseteric nerve palsy post-tumor resection.
• Clinical manifestations included a mask-like face, drooling, incomplete eye closure, and difficulties with swallowing and speech.
• A 3-stage surgical strategy was employed for bilateral smile reanimation.

Findings:

• The technique utilized a single donor nerve (right masseteric nerve) coapted to a cross-facial nerve graft (sural nerve graft).
• The graft was split to reinnervate ipsilateral and contralateral free functioning gracilis flaps sequentially.
• Successful bilateral smile restoration was achieved, with >10 mm commissure excursion and developed spontaneity.

Implications:

• This innovative approach offers a viable solution for smile restoration in pediatric patients with bilateral facial palsy and limited donor nerve options.
• The technique highlights the potential of neuronal plasticity and physiotherapy in achieving functional recovery.
• Successful reanimation using a single masseteric nerve and free functioning gracilis flaps provides a new reconstructive option for complex facial paralysis cases.