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

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Options for Reconstruction in Patients Presenting with Möebius Syndrome
Alex CS Woollard, BM BSc MRCS, Adriaan O. Grobbelaar, FRCS (plast), Douglas H. Harrison, FRCS (plast).
The Royal Free Hospital, London, United Kingdom.

PURPOSE:
In 1888 Paul Julius Möebius described the eponymous syndrome that involves paralysis of bilateral facial nerves (CN VII) and the rectus external muscles of the eye (CN VI). The aim of surgical treatment is to recreate a spontaneous, symmetrical smile.
METHODS:
Between 1988 and 2006 this unit operated on 20 patients with Möebius Syndrome.
Our approach has evolved from Temporalis muscle transfers to bilateral, free-functioning muscle transfers.
The Accessory, Hypoglossal and the Masseteric branch of the Trigeminal nerve have all been used to re-innervate the muscle.
Initially the functional muscle transfers were performed as a staged procedure (DHH). Currently we (AOG) prefer to perform the surgery as a single, bilateral procedure.
RESULTS:
The series is of 20 patients (ages 4 to 46yrs). There were no flap failures or significant complications in this series. Mean surgical time for staged procedures is 5 hours, and for bilateral procedures is 9hrs.
All patients have been followed up for at least 2 years.
The results were evaluated by an independent panel reviewing both still photographs and video recordings of the patients. All active reanimations were rated as excellent. There was no difference in outcome between bilateral and staged reconstructions.
Children under the age of 10 achieved a greater degree of spontaneity in their final smile.
The Masseteric nerve appears to be the best option for motor reanimation.
CONCLUSION:
The best results in facial re-animation occur when the patient is treated under the age of 10.
One-stage reconstruction, where bilateral muscle transfer is achieved in a single operation, provides results that are comparable with a multi-staged procedure. It has the additional benefit of reducing both the number of general anaesthetics the patient is subjected to and their hospital admissions.
The Masseteric nerve is our donor motor nerve of choice.


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