Facial reanimation flaps often add bulk and produce single-vector smiles, and multivector flaps frequently require challenging intramuscular dissection.
Objective:
To evaluate the effectiveness of sterno-omohyoid flap (SOHF) transfer for dual-vector smile reanimation by measuring upper dental show and oral commissure movement.
Methods:
SOHF transfers from 2017 to 2020 were retrospectively evaluated using eFACE and Emotrics software.
Results:
Four patients with flaccid and one with nonflaccid facial paralysis were identified (four females and one male, median age: 39 years (range: 38–65); two acoustic neuromas, two congenital, one temporal bone fracture). Median follow-up was 20 months (range: 14–26). All flaps received masseteric nerves and two had additional cross-face grafts. Four developed contraction [median time to contraction: 5.5 months (range: 3–10)]. Mean oral commissure excursion and dental exposure improvements were 7.6 ± 4.0 mm (p = 0.03) and 2.9 ± 1.8 mm (p = 0.05), respectively. Dynamic, smile, and midface-smile eFACE improvements were 20.3 ± 6.8 (p = 0.007), 25.5 ± 14.5 (p = 0.03), and 50.5 ± 12.0 mm (p = 0.004) points, respectively. Mean SOHF mass was 14 ± 1.7 g.
Conclusion:
The SOHF is a small flap that provides dual-vector smile reanimation in flaccid and nonflaccid facial paralysis.
Get full access to this article
View all access options for this article.
References
1.
HohmanMH, HadlockTA. Etiology, diagnosis, and management of facial palsy: 2000 patients at a facial nerve center. Laryngoscope. 2014; 124(7):E283–E293.
2.
KleissIJ, HohmanMH, SusarlaSM, MarresHAM, HadlockTA. Health-related quality of life in 794 patients with a peripheral facial palsy using the FaCE Scale: a retrospective cohort study. Clin Otolaryngol. 2015; 40(6):651–656.
3.
IshiiL, GodoyA, EncarnacionCO, ByrnePJ, BoaheneKD, IshiiM. Not just another face in the crowd: society's perceptions of facial paralysis. Laryngoscope. 2012; 122(3):533–538.
4.
CoulsonSE, O'DwyerNJ, AdamsRD, CroxsonGR. Expression of emotion and quality of life after facial nerve paralysis. Otol Neurotol. 2004; 25(6):1014–1019.
5.
FarisC, TesslerO, HeiserA, HadlockT, JowettN. Evaluation of societal health utility of facial palsy and facial reanimation. JAMA Facial Plast Surg. 2018; 20(6):480–487.
6.
HottonM, HuggonsE, HamletC, et al.The psychosocial impact of facial palsy: a systematic review. Br J Health Psychol. 2020; 25(3):695–727.
7.
UrbanMJ, EggerstedtM, VarelasE, et al.Hypoglossal and masseteric nerve transfer for facial reanimation: a systematic review and meta-analysis. Facial Plast Surg Aesthet Med. 2022; 24(1):10–17.
ByrnePJ, KimM, BoaheneK, MillarJ, MoeK. Temporalis tendon transfer as part of a comprehensive approach to facial reanimation. Arch Facial Plast Surg. 2007; 9(4):234–241.
10.
BhamaPK, LindsayRW, WeinbergJS, HohmanMH, CheneyML, HadlockTA. Objective outcomes analysis following microvascular gracilis transfer for facial reanimation: a review of 10 years' experience. JAMA Facial Plast Surg. 2014; 16(2):85–92.
11.
BiglioliF, FrigerioA, RabbiosiD, BrusatiR. Single-stage facial reanimation in the surgical treatment of unilateral established facial paralysis. Plast Reconstr Surg. 2009; 124(1):124–133.
12.
HarrisonDH, GrobbelaarAO. Pectoralis minor muscle transfer for unilateral facial palsy reanimation: an experience of 35years and 637 cases. J Plast Reconstr Aesthet Surg. 2012; 65(7):845–850.
13.
SakumaH, TanakaI, YazawaM, ShimizuY. Multivector functioning muscle transfer using superficial subslips of the serratus anterior muscle for longstanding facial paralysis. J Plast Reconstr Aesthet Surg. 2019; 72(6):964–972.
14.
WangW, CaiY, OrangesC, et al.Sternocleidomastoid muscle transfer for treatment of longstanding facial paralysis: long-term outcomes and complications. In Vivo. 2022; 36(1):501–509.
15.
BoaheneKO, OwusuJ, IshiiL, et al.The multivector gracilis free functional muscle flap for facial reanimation. JAMA Facial Plast Surg. 2018; 20(4):300–306.
16.
MessingerDS, FogelA, DicksonKL. What's in a smile?. Dev Psychol. 1999; 35(3):701–708.
17.
WatanabeY, YamamotoT, HiraiR, SasakiR, AgawaK, AkizukiT. One-stage free transfer of latissimus dorsi-serratus anterior combined muscle flap with dual innervation for smile reanimation in established facial paralysis. J Plast Reconstr Aesthet Surg. 2020; 73(6):1107–1115.
18.
EinL, HadlockTA, JowettN. Dual-vector gracilis muscle transfer for smile reanimation with lower lip depression. Laryngoscope. 2021; 131(8):1758–1760.
19.
AlamDS, HaffeyT, VakhariaK, et al.Sternohyoid flap for facial reanimation: a comprehensive preclinical evaluation of a novel technique. JAMA Facial Plast Surg. 2013; 15(4):305–313.
20.
AlamDS. The sternohyoid flap for facial reanimation. Facial Plast Surg Clin North Am. 2016; 24(1):61–69.
21.
VincentAG, BevansSE, RobitschekJM, GroomKL, HerrMW, HohmanMH. Sterno-omohyoid free flap for dual-vector dynamic facial reanimation. Ann Otol Rhinol Laryngol. 2020; 129(2):195–200.
22.
BoaheneK.Omohyoid free flap for smile and blink restoration. Paper presented at the 12th International Facial Nerve Symposium, August 2017; Los Angeles, CA.
23.
BanksCA, JowettN, AzizzadehB, et al.Worldwide testing of the eFACE facial nerve clinician-graded scale. Plast Reconstr Surg. 2017; 139(2):491e–498e.
24.
GuarinDL, DusseldorpJ, HadlockTA, JowettN. A machine learning approach for automated facial measurements in facial palsy. JAMA Facial Plast Surg. 2018; 20(4):335–337.
25.
FarisC, HeiserA, JowettN, HadlockT. Minimal nasolabial incision technique for nasolabial fold modification in patients with facial paralysis. JAMA Facial Plast Surg. 2018; 20(2):148–153.
26.
VincentAG, BevansSE, RobitschekJM, et al.Masseteric-to-facial nerve transfer and selective neurectomy for rehabilitation of the synkinetic smile. JAMA Facial Plast Surg. 2019; 21(6):504–510.
27.
BraigD, BannaschH, StarkGB, EisenhardtSU. Analysis of the ideal weight of gracilis muscle transplant with regard to the donor nerve and outcome. J Plast Reconstr Aesthet Surg. 2017; 70(4):459–468.
28.
LindsayRW, BhamaP, WeinbergJ, HadlockTA. The success of free gracilis muscle transfer to restore smile in patients with nonflaccid facial paralysis. Ann Plast Surg. 2014; 73(2):177–182.
29.
MillerMQ, JowettN, HadlockTA. Lessons from gracilis free tissue transfer for facial paralysis: now versus 10 years ago. Facial Plast Surg Clin N Am. 2021; 29(3):415–422.
30.
ByrnePJ, NovingerLJ, GentherDJ. Tri-vector gracilis microneurovascular free tissue transfer with periocular component to achieve a Duchenne smile in patient with facial paralysis. Facial Plast Surg Aesthet Med. 2022; 24(6):494–496.
31.
WhitneyTM, BunckeHJ, AlpertBS, BunckeGM, LineaweaverWC. The serratus anterior free-muscle flap: experience with 100 consecutive cases. Plast Reconstr Surg. 1990; 86(3):481–490.
32.
AlleviF, MottaG, ColomboV, BiglioliF. Double-bellied latissimus dorsi free flap to correct full dental smile palsy. BMJ Case Rep. 2015; 2015:bcr2015210436.
33.
UedaK, HariiK, YamadaA. Free vascularized double muscle transplantation for the treatment of facial paralysis. Plast Reconstr Surg. 1995; 95(7):1288–1296.
FarisC, HeiserA, HadlockT, JowettN. Free gracilis muscle transfer for smile reanimation after treatment for advanced parotid malignancy. Head Neck. 2018; 40(3):561–568.
36.
OyerSL, NellisJ, IshiiLE, BoaheneKD, ByrnePJ. Comparison of objective outcomes in dynamic lower facial reanimation with temporalis tendon transfer and gracilis free muscle transfer. JAMA Otolaryngol Head Neck Surg. 2018; 14(12):1162–1168.
37.
BiglioliF, ColomboV, TarrabiaF, et al.Double innervation in free-flap surgery for long-standing facial paralysis. J Plast Reconstr Aesthet Surg. 2012; 65(10):1343–1349.
38.
Cardenas-MejiaA, Covarrubias-RamirezJV, Bello-MargolisA, RozenS. Double innervated free functional muscle transfer for facial reanimation. J Plast Surg Hand Surg. 2015; 49(3):183–188.
39.
KimMJ, KimHB, JeongWS, ChoiJW, KimYK, OhTS. Comparative study of 2 different innervation techniques in facial reanimation: cross-face nerve graft-innervated versus double-innervated free gracilis muscle transfer. Ann Plast Surg. 2020; 84(2):188–195.
40.
WatanabeY, AkizukiT, OzawaT, YoshimuraK, AgawaK, OtaT. Dual innervation method using one-stage reconstruction with free latissimus dorsi muscle transfer for re-animation of established facial paralysis: simultaneous reinnervation of the ipsilateral masseter motor nerve and the contralateral facial nerve to improve the quality of smile and emotional facial expressions. J Plast Reconstr Aesthet Surg. 2009; 62(12):1589–1597.
41.
BoonipatT, RobertsonCE, MeaikeJD, VyasKS, AsaadM, MardiniS. Dual innervation of free gracilis muscle for facial reanimation: what we know so far. J Plast Reconstr Aesthet Surg. 2020; 73(12):2196–2209.
42.
IacolucciCM, BanksC, JowettN, et al.Development and validation of a spontaneous smile assay. JAMA Facial Plast Surg. 2015; 17(3):191–196.
43.
LenzY, KieferJ, DietrichF, StarkGB, EisenhardtSU. Pre-operative masseter muscle EMG activation during smile predicts synchronicity of smile development in facial palsy patients undergoing reanimation with the masseter nerve: a prospective cohort study. J Plast Reconstr Aesthet Surg. 2019; 72(3):505–512.
44.
SforzaC, FrigerioA, MapelliA, et al.Double-powered free gracilis muscle transfer for smile reanimation: a longitudinal optoelectronic study. J Plast Reconstr Aesthet Surg. 2015; 68(7):930–939.
45.
TerzisJK. Pectoralis minor: a unique muscle for correction of facial palsy. Plast Reconstr Surg. 1989; 83(5):767–776.
46.
MacQuillanA, HorlockN, GrobelaarA, HarrisonD. Arterial and venous anatomical features of the pectoralis minor muscle flap pedicle. Plast Reconstr Surg. 2004; 113(3):872–876.
47.
GuptaP, BhallaAS, ThulkarS, et al.Variations in superior thyroid artery: a selective angiographic study. Indian J Radiol Imaging. 2014; 24(1):66–71.
48.
WonSY. Anatomical considerations of the superior thyroid artery: its origins, variations, and position relative to the hyoid bone and thyroid cartilage. Anat Cell Biol. 2016; 49(2):138–142.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
