Basic Research And Clinical Application For The Treatment Of Terminal Facial Paralysis With Denerved Free Muscle Transplantation

【Objective】The restoration of terminal facial paralysis is difficult.There are many kinds of method. But there is not a single method whichcan restore all the deformities. The methods include staticreconstruction and dynamic reconstruction. The latter can be divided intonerve transplantationand muscle transplantation. There are three methodsin muscle transplantation for restoration of facial paralysis, i.epedicled muscle transplantation, muscle transfer with anastomosis ofblood vessels and/or nerves and denerved free muscle transfer. The latteris the method we have applied. Because the facial expressional muscles aresmall , we should choose small muscle for restoration according toplastic principle. We need to research denerved free small muscletransplantation or muscular bundle transplantation which has independentnerve. The denerved free muscle transplantation, history review, anatomy,animal experiment and restoration method for facial paralysis should bediscussed in this article.【Method】At the aspect of basic study, we have researched the mechanismof free muscle transplantation. We have taken the animal experiment toexplore denerved free muscle transplantation by BOTOX A injection indifferent denerved period. Denerved extensor carpi radialis muscle ofrabbit was transplanted. Biopsy was taken in different period forhistological and morphologic examinations. For selection of donor muscle,the anatomy of rectus abdominis muscle was managed in the number oftendinous intersections below and upper of navel, muscle' swidth, lengthand nerve distributions of tendinous intersections, which help to choose part of rectus abdominis muscle for facial paralysis restoration. At theaspect of clinical application, We have applied biochemical method todenerve muscles, including extensor digitorum brevis, extensor hallucisbrevis, rectus abdominis muscle and palmaris longus, and then transferredthe muscles for restoration of facial paralysis. The propertransplantation time is good for survival of muscle and innervation.【Result】It has been found that 3 weeks after denerve muscle is thebest period of muscle transfer for the lowest metabolize ratio, thehighest muscle surviving ratio. The method of free transplanted muscleafter being denerved three weeks stimulat the nerve to regenerate rapidlyand possibly, shorten the centracture time of muscle and nerve. The musclecan survive previous to atrophy, and nerve can grow into graft previousto its fibrosis. In research for anatomy of rectus abdominis muscle, wehave found that two muscular segments, which is best choice for muscletransplantation. And we have applied the method on three kinds of musclewhich is coincident with free muscle transplantation request, especiallyrectus abdominis muscle transplantation which obtained double nervedistribution. We have obtained good result.【Conclusion】the method of restoring terminal facial paralysis withbiochemical denerved muscle transfer can obtained static restoration atrecent time and dynamic reconstruct at distant time. The technique issimple and efficient. The method is an ideal one to reconstruct terminalfacial paralysis and may be popularized in clinic.