Abstract: Several techniques for transposition of the masseter or temporal muscles have been used and some restoration of movment has been reported. With few exception, however, it is difficult to obtain acce p-table results with these operations, because the transposed muscle has an unfavourable direction of the line of pull and this disadvantage is combined with a limited scope of contraction. An excellent procedure-transplantation of free autogenous muscle in the treatment of facial paralysis was described by Thompson in 1971. This is a great breakthrough in reconstruction surgery.
This operation was performed in two steps:
1. Palmalis longus muscle was denervated 2—3 weeks prior to transplatation. The authors claimod that the favorable outcome following denervation is the result of a change in the enzyme constitution of the muscle fibre to a more economic level of metablism, which made it possible for the transplant to survive the period of avascularity before the reestablishment of effective circulation.
2. Reconstraction of orbicularis oris: The intention of the operation is to encircle the mouth with a denervated muscle graft, thereby obtaining reinnervation from the normal half of the orbicularis oris muscle. The muscle transplant was split longitudinally, paralleling with the lay of its fibres, as far as the tendinous attachment. The tendon of transplant was passed subcutaneously to the zygomatic arch and fixed around this bone in order to give static support, keeping the mouth in a balanced position when the face was at rest.
We used this procedure for treating a female patient of 45 years in age with total right-side facial palsy caused by operation for a acoustic nerve tumor two years ago. Postoperatively the patient was observed for 4 more months. She showed improvement of spincteric action on pursing the lips and whistle, which was previously imposible. EMG examination showed reinnervalion of free muscle graft.