Dual-innervated Free Functional Flap Transfer and Mandibular Distraction in Patients with Hemifacial Microsomia
Year: 2025
Type: article
Study design: Case Report
Abstract: Hemifacial microsomia has been reported as the second most common congenital craniofacial malformation. The aim is to present a representative case of a patient who underwent both surgical procedures for the integrated care of hemifacial microsomia. The surgical technique for dynamic facial reanimation was a two-stage procedure due to masseter function impairment. The first one consisted of a cross-facial nerve graft, which was coapted to the masseteric nerve on the contralateral side, and the second stage consisted of a gracilis muscle transfer, in which the obturator nerve was coapted to the masseteric nerve on the ipsilateral side (a dual-innervated free functional gracilis flap). Mandibular distraction was performed a year after the second stage of facial reanimation. At the five-year follow-up, the patient had sustained a satisfactory, aesthetic, and pleasant result. No further secondary or revision procedures have been needed. Objectively, we observed bite-force enhancement, as demonstrated by electromyography. In our experience, we recommend performing microsurgical facial reanimation first, followed by mandibular distraction, and finally, autologous ear reconstruction.
Authors: Damián Palafox, Alexander Cárdenas-Mejía
Institution: Hospital General Dr. Manuel Gea Gonzalez
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4413185063