Simultaneous Reconstruction of Voluntary and Spontaneous Smiles and Eyelid Closure With Triple Latissimus Dorsi Muscle Flaps

Ryousuke Matsusaka; Mutsumi Okazaki; Kentaro Tanaka; Noriko Uemura; Hiroki Mori; Tsutomu Homma; Koji Kanayama

doi:10.1097/SCS.0000000000010818

Simultaneous Reconstruction of Voluntary and Spontaneous Smiles and Eyelid Closure With Triple Latissimus Dorsi Muscle Flaps

J Craniofac Surg. 2024 Oct 31. doi: 10.1097/SCS.0000000000010818. Online ahead of print.

Authors

Ryousuke Matsusaka¹, Mutsumi Okazaki¹, Kentaro Tanaka², Noriko Uemura³, Hiroki Mori³, Tsutomu Homma⁴, Koji Kanayama¹

Affiliations

¹ Department of Plastic and Reconstructive Surgery, University of Tokyo Graduate School of Medicine.
² Department of Reconstructive Plastic Surgery, Institute of Science Tokyo, Bunkyo-ku, Tokyo.
³ Department of Plastic and Reconstructive Surgery, Institute of Science Tokyo, Bunkyo-ku, Tokyo, Japan.
⁴ Department of Reconstructive and Cosmetic Surgery, Kashiwa Kousei General Hospital, Kashiwa, Chiba.

PMID: 39480101
DOI: 10.1097/SCS.0000000000010818

Abstract

Using the free latissimus dorsi muscle flap for dynamic reconstruction for established facial paralysis helps reconstruct various facial dysfunctions, depending on nerve and muscle arrangements. The authors divided the latissimus dorsi muscle into 3 flaps, 2 placed in the cheek area to reconstruct a "voluntary and spontaneous smile" and 1 fixed to the fascia implanted in the eyelid to treat lagophthalmos in a 1-stage procedure in a 61-year-old woman who underwent tumor resection for a left facial nerve schwannoma and developed complete facial paralysis. Fascia lata and free latissimus dorsi muscle grafting were performed. Spontaneous smile was reconstructed using the contralateral facial nerve as a motor source. Voluntary smile and eyelid closure were reconstructed using the ipsilateral masseter nerve, dividing the latissimus dorsi muscle flap into 3 muscle bodies. This procedure restored her smile and eyelid closure ability, with a nearly normal overall facial impression, making it a valuable technique for 1-term reconstruction of smiles and eyelid closure.