Single-Stage Facial Reanimation in the Surgical Treatment of Unilateral Established Facial Paralysis

Background: Surgical treatment of unilateral long-standing facial paralysis requires transposition of new musculature to restore the function of the atrophied mimetic musculature. Facial reanimation with free neuromuscular flaps is actually the accepted standard treatment. Two-stage procedures have been used for years, with a total flap recovery time of 18 to 24 months. In 1998, Harii proposed single-stage facial reanimation using the latissimus dorsi flap, showing a faster recovery compared with two-stage procedures. The present study evaluated the results of the authors' center applying the single-stage facial reanimation. Methods: From April of 1999 to April of 2006, 33 patients with unilateral established facial paralysis underwent single-stage facial reanimation via latissimus dorsi free flap transplantation. Time from the onset of paralysis ranged from 20 months to 64 years (mean, 11.6 years). Patients were followed postoperatively for at least 24 months. Results were studied and compared using Terzis and Noah's 1997 classification. Results: Among the 33 patients included in the study, there was an average reinnervation time of 8.9 months. According to Terzis and Noah's classification system, 12 patients (36.3 percent) were considered grade V, 12 (36.3 percent) were grade IV, four (12.2 percent) were grade III, two (6.1 percent) were grade II, and three (9.1 percent) were grade I. Conclusions: Single-stage facial reanimation with a latissimus dorsi flap achieved morphofunctional results similar to those obtained with the classic two-stage technique. In addition, the authors were able to reduce the morbidity associated with treatment and the time required for recovery. (Plast. Reconstr. Surg. 124: 124, 2009.)