Facial Paralysis Correction with Masseter Muscle Flap Transposition

The chewing muscle flap transposition facial paralysis is used for the treatment of facial paralysis. The procedure is to make the chewing muscle pedicle flap forward, and the tissue around the angle of the affected side is fixed, and the movement of the sacral surface is performed by using the biting motion. However, the resulting facial movement is inconsistent with the natural movement of the healthy side, and it takes a period of training to achieve the desired purpose. Treating diseases: facial paralysis Indication The chewing muscle flap transposition facial paralysis correction is suitable for obvious obstruction of the nose and mouth caused by old peripheral or central facial paralysis. Preoperative preparation 1. Predetermine the position of the corrected angular position. The principle is to make the mouth angle over the orthostatic position, that is, 0.5cm above the healthy side and 0.5cm above the healthy side. Skin relaxants also need to consider the amount of skin removed at the nasolabial fold. 2. Measure the length of the affected side of the chewing muscle, which should be 0.5cm below the zygomatic arch and the distance from the midpoint of the sigmoid to the mandibular angle. At the same time, the distance from the midpoint of the sigmoid notch to the corrected angle of the mouth was measured to estimate the tension after the chewing muscle flap was fixed. 3. Regular preparation of skin in the mouth and submandibular area. Surgical procedure Incision The following anterior notch of the mandibular angle is centered, and a 5-6 cm arc-shaped incision is made 1.5 cm from the lower edge of the lower jaw. The incision lip red edge incision or the nasolabial incision is 3 to 5 cm long. 2. Reveal the chewing muscles After the skin, subcutaneous tissue and platysma are cut open, the external maxillary artery and the anterior vein are separated at the lower margin of the lower jaw and the front of the chewing muscle, and the ligation and cutting treatment can also be performed. The lower edge of the lower jaw is separated posteriorly to the mandibular angle to expose the lower edge of the chewing muscle. Cut the chewing muscle fascia up and flap the cheek muscle to the lower edge of the zygomatic arch. Protect the parotid duct. 3. Forming a chewing muscle flap In the direction of the sigmoid notch to the mandibular angle, the superficial muscle fibers of the chewing muscles cut the chewing muscles to the mandibular ascending bone surface, and cut off the starting point of the chewing muscles, and the bones face up to the lower edge of the sigmoid notch. Form a pedicle muscle flap. 4. Form a tunnel Incision along the red lips of the upper and lower lip corners, or incision of the nasolabial fold, in the subcutaneous tissue layer, fan-shaped blunt separation from the zygomatic arch and the mandibular angle, from the front edge of the chewing muscle, and the submandibular incision Through, forming a tunnel that is wide enough. 5. Traction and trimming muscle flaps The lower end of the chewing muscle flap is pulled forward and upward, and is pulled out from the mouth or nasolabial fold through the tunnel. The pulling tension should be slightly larger than the tension of the chewing muscle in situ. The distal end of the chewing muscle flap is divided into 3 bundles, and the middle bundle is trimmed according to the new angular position to reach the site determined in the plan. 6. Fixed muscle flap The ends of the three muscles were sewed through the line 4, and then sutured and fixed in the submucosal tissue of the upper lip, the mouth and the subordinate, and the orbicularis oculi muscle. Stitching and ligation must be secure. 7. Close the incision and place the drainage After completely stopping bleeding, flush the wound with saline. The loosened skin is trimmed according to a predetermined angular position, and the subcutaneous tissue and skin are layered and sutured. The submandibular area incision was sutured, and a half-tube drainage strip was placed on the surface of the mandibular ascending branch. 8. Bandaging Elastic bandages were used to make the mandibular bandage of the lateral side, focusing on the lower jaw and cheeks. complication 1. Injury the chewing muscle nerve. 2. Damage to the chewing muscles. 3. Injury of the parotid duct and parotid gland. 4. Hematoma. 5. The fixed stitch is loose.