第一阶段 - 跨面神经移植微笑 - 标准

                               
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Facial paralysis causes significant morbidity and dynamic reconstruction aims to address functional, aesthetic, and psychological aspects of the impairment. Cross-facial nerve grafting is a reconstructive strategy used to restore smile function and eye closure in both acute and chronic unilateral injury. In an acute injury, nerve grafting provides regenerating fibers from the donor nerve on the normal side to reinnervate across the face to the similar recipient nerve on the paralyzed side. In a chronic injury where the paralyzed muscle can no longer be reinnervated, the cross-facial nerve graft serves as the first stage to a segmental free functional muscle transfer to reconstruct smile. In this case, the patient presented 4-years-ago with a posterior fossa medulloblastoma, which was removed, and underwent a successful course of chemotherapy. However, the tumor involved partial CN12 and complete CN6 and CN7 nerve paralysis on the left side. Reconstruction included a 2-stage segmental gracilis muscle transfer to reconstruct smile with stage one providing the donor nerve source for the muscle. This video details the selection of the donor buccal branch of the contralateral facial nerve and coaptation of the sural nerve graft as the cross-facial nerve graft. The specifics of the sural nerve harvest are not included in this video.

Table of Contents (Standard)
00:25 Developing a Facial Pocket with Unipolar Cautery
01:35 Developing a Facial Pocket with Scissor Dissection
03:11 Identifying and Exposing the Contralateral Buccal Branch of Facial Nerve
04:30 Mapping of Contralateral Facial Nerve through Electrical Stimulation
05:33 Exposure of Upper Gingival Buccal Sulcus to the Periosteum
06:09 Tunneling the Nerve Graft from the Upper Buccal Sulcus to the Buccal Nerve Branch
06:58 Dividing the Buccal Branch of Contralateral Facial Nerve
07:32 Coaptating the Buccal Branch to the Proximal End of Nerve Graft
08:14 Suturing the Distal End of Nerve Graft to the Periosteum
09:28 Closure

Authors: Ronald M. Zuker, Gregory H. Borschel, Karen W. Y. Wong, Alison K. Snyder-Warwick, Andrew Yee