Facial reanimation by transplantation of a microneurovascular muscle: long-term follow-up

Abstract

The two-stage operation for reanimation of long-standing facial paralysis by cross-facial nerve grafting and later free microneurovascular muscle transfer has been the treatment of choice for nearly 25 years. However, the functional outcome may be unpredictable. We therefore need to know more about the factors that influence the final result. We have recorded the long-term results of microneurovascular surgery in facial paralysis, and evaluated which factors influenced the functional outcome. Twenty-seven of 40 patients aged 7 to 65 years (mean 40) operated on at Helsinki University Hospital between 1986 and 2000 were available for interview and video recording. The gracilis, latissimus dorsi, and serratus anterior muscles were used for microneurovascular transfer in 11, 10, and 6 cases, respectively. The outcome of microneurovascular muscle transfer was graded on House's scale 1 to 6. The mean follow-up period was 8.5 years (range 2 to 15). Sixteen patients (59%) displayed only mild or moderate dysfunction (grades 2 to 3) after reconstruction. In 8 patients (30%) dysfunction was graded as moderately severe, and in 3 (11%) as severe. There was a correlation between final functional outcome and the follow-up time after microneurovascular facial reanimation. The longer the follow-up time after muscle transplantation the poorer the functional result (p = 0.003). Twenty-one patients (78%) considered that their quality of life was better or much better after facial reanimation. Patients' satisfaction correlated with a good functional result.