以Mobius综合征为例微笑节段性胃肌肌肉转移 - 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. Segmental gracilis muscle transfer is a reconstructive strategy used to restore smile function in a chronic injury, where nerve grafting or nerve transfers are no longer an option due to prolonged muscle atrophy or congenital causes. In this case, the patient presented with a congenital neurological disorder called Möbius syndrome, which involved complete bilateral paralysis of CN6, CN7 and partial paralysis of CN12. The patient's inability to smile was due to the absence of facial muscles. A bilateral segmental muscle transfer was elected to reconstruct smile using the gracilis muscle with neurotization with the masseteric nerve. Often, patients with Möbius syndrome do not have a facial vein, as in this patient, and the transverse facial vein and the facial artery were utilized for vascular anastomosis. This video portrays the approach and technical details for performing a segmental gracilis muscle transfer using the donor masseteric nerve.

Table of Contents (Standard)
00:25 Developing a Facial Pocket with Unipolar Cautery
02:35 Developing a Facial Pocket with Scissor Dissection
02:56 Exposing the Facial Artery
03:27 Identifying the Transverse Facial Vein
04:57 Debulking the Buccal Fat Pad
06:07 Dividing the Facial Artery
07:43 Dissection to the Labial Commissure
08:15 Suture Anchoring of the Labial Commissure and Creation of New Nasolabial Fold
10:39 Exposure and Division of the Donor Masseteric Nerve
12:48 Gracilis Muscle Harvest with Dominant Pedicle
14:59 Placement of Reinforcing Sutures into the Gracilis Insertion
17:31 Suture Technique for Inserting the Gracilis to the Commissure Using the Anchors
22:58 Anastomoses of Donor/Recipient Vessels and Coaptation of Donor/Recipient Nerve
23:47 Suturing the Gracilis Origin to the Temporal Fascia
25:52 Inspecting the Vascular Anastomoses and Nerve Coaptation

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