AAPS, American Association of Plastic Surgeons
AAPS, American Association of Plastic Surgeons
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2008 Annual Meeting Abstracts

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Free functional muscle transfer for facial paralysis - 500 cases later.
Adriaan O. Grobbelaar, MBChB, MMed(Plast) FRCS(Plast), Douglas H. Harrison, FRCS.
Royal Free Hospital, LONDON, United Kingdom.

PURPOSE: The senior author was one of the pioneering surgeons that established free functional muscle transfers as the gold standard for the treatment of facial paralysis. The aim is to present the results of 500 cases performed between 1981 and 2007 (DHH 370, AOG 130).
METHODS: A two stage approach (cross facial nerve graft followed by a free functional muscle transfer) was performed in the majority of cases with at least a six month pause between the two procedures. The pectoralis minor muscle was used in 446 cases and the latissimus dorsi in 54. 56% of patients were female and 44% male. The age of the patients at the time of the second stage ranged from five years to sixty-four years. All patients were followed up for at least one year post the second surgery.
RESULTS: Results were graded by a an independent panel and 57% achieved an excellent result while 34% achieved a good result. 15% of patients had a third operation to further enhance their outcome. A V-Y closure of the angle of the mouth and thinning of the muscle were the most commonly performed adjustments. Children has a statistically significantly higher incidence of achieving an excellent result (p<0.007). Five percent of patients developed late tightening of the transfered muscle. Surgical experience is a key factor and both surgeons achieved excellent results more consistently after the first 50 cases (p<0.0001)
CONCLUSION:
Free functional muscle transfers are an established method for dynamic re-animation of the face. Children has a higher success rate as judged by achieving of an excellent result. Our data suggests that functional muscle transfers should not be attempted by the occasional operator.


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