Facial paralysis that has been caused by trauma, tumour excision or congenital facial palsy, can be treated by dynamic muscle transfer. This is a two-stage reanimation procedure that involves grafting nerves from the side of the body that is unaffected by paralysis and crossing them over to the other side. It’s a very complex technique that allows your own natural nerve fibres to grow and develop on the affected side of the face.
Understanding the dynamic muscle transfer procedure
The first stage of the dynamic muscle transfer is to take a nerve graft from the sural nerve located in the leg. The graft is placed in the unaffected side of the face, attaching it to the facial nerve. It is then passed over to the opposite, affected side. Over a three-month period, the axonal fibres begin to grow from the unaffected side of the face, over to the paralysed side. These can then be used as a successful nerve source for a free muscle flap.
After three months, the free muscle flap is inserted and that works to reproduce the facial movements that have been lost. The muscle is taken usually from either the thigh or the chest. Mr Paul Tulley then uses a microsurgical free transfer procedure to then insert it into the face. The nerve fibres that have grown over the first three months then start to grow into the muscle flap. It is these which help the flap to start moving to create facial expressions.
Am I suitable for a dynamic muscle transfer procedure?
Dynamic muscle transfer is ideally suited to younger patients as they tend to have much better growth potential. However, there is no age limit on the procedure. It is especially useful for patients who find it difficult to smile and who have suffered with facial palsy for at least two years.
The procedure will be carried out under general anaesthetic and there are several risks you need to prepare for. These will be explained fully by Mr Tulley during your consultation, but they include asymmetry and problems with the wound healing.
Facial Palsy: Introduction
Bell’s Palsy and Treatment
Facial Palsy: Eyelid Surgery
Adjunctive Procedures – Brow and Facelift