A DOUBLE-MUSCLE TRANSFER USING A DIVIDED RECTUS FEMORIS MUSCLE FOR FACIAL-PARALYSIS RECONSTRUCTION

There are two types of smiling: without exposure of the teeth (usual s mile), and with their exposure (square smile). Performance of the form er involves use of the major zygomatic muscle, while the latter is cre ated by the major zygomatic and the depressor labii inferior muscles. The function of the depressor labii inferioris muscle cannot be ignore d in facial paralysis reconstruction. A double-muscle transfer using a divided rectus femoris muscle for one-stage reconstruction of both th e major zygomatic muscle and the depressor labii inferior muscle is de scribed. The patient suffered facial paralysis caused by an extracrani al schwannoma originating from the facial nerve. After the tumor was r emoved, divided rectus Femoris muscle segments were transferred to rec onstruct the major zygomatic muscle and the depressor labii inferior m uscle. After the pedicle vessel of the muscles was anastomosed to the recipient Facial vessel, the long motor nerve of the proximal divided muscle was cross-faced and coapted directly to the prepared contralate ral buccal branch. The short motor nerve of the distal muscle segment was sutured to the ipsilateral masseteric nerve. The advantages of div ided rectus femoris muscle transfers are that (1) independent muscle c ontraction can be reconstructed; (2) no tongue or trapezius muscle atr ophy occurs because the masseteric nerve is used as the motor source o f the labial depressor; (3) only one muscle is sacrificed for muscle g rafts; and (4) it is a one-stage reconstruction.