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Oculo-zygomatic nerve transfer for facial synkinesis: An anatomical feasibility study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.ORCID iD: 0000-0002-6353-7070
Center of Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
Center of Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.
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2019 (English)In: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 37, no 7, p. 629-633Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Patients with severe oro-ocular synkinesis often present with concomitant inefficient smile excursion on the affected site. In theory, oculo-zygomatic nerve transfer may decrease synkinesis and improve smile by redirecting nerve fibers to their target muscle. The aim of this study was to explore the feasibility of nerve transfer in human cadavers between a caudal branch innervating the orbicularis oculi to a cephalad branch innervating the zygomaticus major muscles.

METHODS: Eighteen hemi-faces were dissected. Reach for direct coaptation of a caudal nerve branch innervating the orbicularis oculi muscle to a cephalad nerve branch innervating the zygomaticus major muscle was assessed. Measurements included total number of nerve branches as well as maximum dissection length. Nerve samples were taken from both branches at the site of coaptation and histomorphometric analysis for axonal count was performed.

RESULTS: The number of sub-branches to the orbicularis oculi muscle was 3.1 ± 1.0 and to the zygomaticus major muscle 4.7 ± 1.2. The maximal length of dissection of the caudal nerve branch to the orbicularis oculi muscle was 28.3 ± 7.3 mm and for the cranial nerve branch to the zygomaticus major muscle 23.8 ± 6.5 mm. Transection and tension-free coaptation was possible in all cases but one. The average myelinated fiber counts per mm2 was of 5,173 ± 2,293 for the caudal orbicularis oculi branch and 5,256 ± 1,774 for the cephalad zygomaticus major branch.

CONCLUSION: Oculo-zygomatic nerve transfer is an anatomically feasible procedure. The clinical value of this procedure, however, remains to be proven.

Place, publisher, year, edition, pages
2019. Vol. 37, no 7, p. 629-633
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-394138DOI: 10.1002/micr.30457ISI: 000490018500007PubMedID: 30957287OAI: oai:DiVA.org:uu-394138DiVA, id: diva2:1357441
Available from: 2019-10-03 Created: 2019-10-03 Last updated: 2019-11-06Bibliographically approved
In thesis
1. Sequelae after Facial Palsy: Clinical, Anatomical and Electrophysiological Studies
Open this publication in new window or tab >>Sequelae after Facial Palsy: Clinical, Anatomical and Electrophysiological Studies
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Sequelae after peripheral facial palsy, which among others include synkinesis, non-functional smile and/or lower lip asymmetry, may be devastating for the patient. Bell’s palsy is the most common form of peripheral facial palsy. 

Aim: The aim was to study a) frequency and potential predictive factors of synkinesis in Bell’s palsy b) new surgical treatment options after facial nerve injury c) coactivation between muscles innervated by the facial nerve and the most common donor nerves in smile reanimation d) anatomical features of the lower lip depressors. 

Methods: I: Frequency, severity and early predictors of synkinesis development were studied in 829 Bell’s palsy patients. II and IV: Anatomical technical feasibility of intra-facial nerve transfers was analyzed. V: Anatomical features of lower lip depressor muscles were studied and a literature review for lower lip depressor myectomies was performed. III: Coactivation of muscles innervated by cranial nerves during voluntary facial movements was measured with electromyography. 

Results: I: In Bell’s palsy, synkinesis frequency was 21.3% at 12-months and Sunnybrook composite score at one month was found to be a good predictor for synkinesis. II and IV: A tension-free oculo-zygomatic and platysma-marginal mandibular nerve transfer was anatomically feasible. Full recovery of the lower lip after platsysma-marginal mandibular nerve transfer was found in a clinical case. III: The masseter muscle had a narrower coactivation pattern compared to the tongue. Bite induced a strong coactivation in the zygomaticus major muscle. V: The width of the depressor labii inferioris was 20 ± 4 mm and the distance from the midline to the lateral muscle border was 32 ± 4 mm. For the depressor anguli oris muscle, the corresponding measurements were 14 ± 3 mm and 54 ± 4 mm. The mean recurrence rate after lower lip myectomy reported in the literature is 21%.  

Conclusion: I: Synkinesis in Bell’s palsy was 21%. Sunnybrook composite score at one month is a good predictor for synkinesis. II: Oculo-zygomatic nerve transfer may be a suitable technique to reduce eye synkinesis and achieve a stronger smile. III: The narrow coactivation pattern in the masseter muscle may be advantageous for spontaneous smile development. IV: The platysma motor nerve transfer is a feasible procedure and can lead to full recovery in lower lip paralysis. V: Knowledge of the width of the depressor muscles is of importance to ensure complete resection in lower lip myectomy.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 44
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1601
Keywords
Facial palsy, Marginal mandibular paralysis, Smile reconstruction, Synkinesis
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-394136 (URN)978-91-513-0766-4 (ISBN)
Public defence
2019-11-30, Skoog salen, Ingång 78-79, Akademiska sjukhuset, Uppsala, 09:00 (English)
Opponent
Supervisors
Available from: 2019-11-11 Created: 2019-10-03 Last updated: 2019-11-27

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Jensson, DavidJonsson, LarsRodriguez-Lorenzo, Andres

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