Paralysis of the marginal mandibular branch of the facial nerve: treatmentoptions

Isolated paralysis of the marginal mandibular branch of the facial nerve re sults in an asymmetrical smile with elevation of the lower lip on the affec ted side. We discuss the surgical options for its correction and pre sent a series of 26 patients who underwent either botulinum toxin injection, ante rior belly of digastric transfer or free extensor digitorum brevis transfer as treatment. Botulinum toxin injection provided satisfactory results alth ough these were temporary. Anterior belly of digastric transfer was the sur gical procedure of choice. It yielded superior cosmetic results, less donor -site morbidity and required a shorter operating time. In more complex cong enital facial hypoplastic syndromes, or following extensive surgery in the digastric triangle, the anterior belly of the digastric muscle may be absen t or damaged. Extensor digitorum brevis transfer is the preferred option in these cases. (C) 2000 The British Association of Plastic Surgeons.