Microvascular Free Tissue Transfer for Facial Reanimation of the Paralyzed Face

Preoperative facial weakness may be caused by extracranial, intratemporal, or intradural facial nerve invasion by a variety of benign and malignant lateral skull base or posterior fossa neoplasms. Interposition facial nerve grafting is not possible when the paralysis is longstanding, when the facial musculature must be resected, or if a proximal facial nerve stump is not available. In these situations, the best possible alternative is free tissue transfer when the goal is restoring dynamic facial function. This paper outlines the use of microvascular free tissue transfer techniques that can be used for both defect reconstruction and dynamic facial reanimation. The most commonly used free flaps for facial reanimation are the gracilis, latissimus dorsi, serratus anterior, and inferior rectus abdominus muscle.

Donor muscle flap selection and surgical technique will be described and case examples will be detailed.