Functional reconstruction of the lateral face after ablative tumor resection: Use of free muscle and musculocutaneous flaps

Background. Wide resection of tumors of the middle third of the face often results in complex three-dimensional defects and facial paralysis either du e to removal of the facial nerve within the tumoral tissue or to extensive resection of the facial muscles. Methods. We report the cases of three patients who underwent wide excision of tumors of the cheek region, operations that resulted in tissue defects a nd facial palsy. Defect reconstruction and facial reanimation was accomplis hed in one stage through functional muscle transplantation. Results. Follow-up of more than 1 year showed good symmetry at rest and rea nimation of the corner of the mouth in all cases, but one patient, in which the ipsilateral facial main trunk was used as motor nerve supply to the tr ansplanted muscle, developed significant muscle contracture and binding of the cheek skin. Conclusions. Every effort should be made to optimize the functional and cos metic outcomes of neurovascular muscle transfers through precise planning a nd careful execution of the intricate details of the surgical technique for muscle transplantation. (C) 2001 John Wiley & Sons, Inc.