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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
A Journal on Maxillofacial Surgery
Official Journal of the Italian Society of Maxillofacial Surgery
Italian Journal of Maxillofacial Surgery 2008 August;19(2):57-63
Facial animation in patients with Moebius syndrome
Bianchi B., Copelli C., Ferrari S., Ferri A., Sesenna E.
Maxillofacial Surgery Head and Neck Department University of Parma, Parma, Italy
Aim. Moebius syndrome, a rare congenital disorder of varying severity, involves multiple cranial nerves and is characterised predominantly by paralysis of the facial and abducens nerves. Lateral gaze and facial animation are absent, and the inability of these patients to smile often leads to the mistaken impression that they are dull and uninterested. Facial paralysis often causes bilabial incompetence with speech difficulties, oral incompetence, problems with eating and drinking, including pocketing of food in the cheek and dribbling, as well as severe drooling.
Methods. In this study, we report of 32 patients with Moebius syndrome seen from 2003 to May 2008 at the Operative Unit of Maxillofacial Surgery, Head and Neck Department, University of Parma, Italy. Ten of those patients underwent facial reanimation with gracilis muscle transplantation. We review the surgical technique used and we focus on functional issues such as oral competence, speech and the extent of animation and its impact on these patients.
Results. In this series, all free-muscle transplantations survived transfer, and no flap was lost. Facial symmetry was excellent or good in all patients both at rest and whilst smiling and we observed a significant improvement in speech and oral competence.
Conclusion. The gracilis muscle represents a safe and reliable choice for facial animation, having the advantages of easy access, dispensability and appropriate vasculature for free transfer. A special attention should be made in careful preoperative study of the patient, precise selection of the motor nerve, good positioning of the muscle and continuous postoperative smile and speech training.