The Distal Stump of the Intramuscular Motor Branch of the Obturator Nerve Is Useful for the Reconstruction of Long-Standing Facial Paralysis Using a Double-Powered Free Gracilis Muscle Flap Transfer.

Background:Double innervation of the transferred muscle with the contralateral facial nerve and the ipsilateral masseteric nerve has recently been reported by some authors. The aim of this study was to assess the utility of our procedure of double innervation of free gracilis muscle for reconstruction of long-standing facial palsy.Patients and Methods:In our department, 6 cases of long-standing facial paralysis (4 cases of complete palsy and 2 of incomplete palsy) were reconstructed using a free gracilis muscle double innervated with the masseteric and contralateral facial nerves. The patient age ranged from 37 to 79 years (average 56.715.7). In our procedure, the intramuscular motor branch of the transferred muscle was identified and sutured to the ipsilateral masseteric nerve in an end-to-end fashion, and the obturator nerve of the transferred muscle was sutured to the cross-facial nerve graft, which was coapted with the contralateral facial nerve by end-to-end suturing.Results:All patients were followed up for >18 months and recovered their smiling function. The voluntary movement of the transferred muscle with teeth clenching was observed at approximately 4.7 months, and this movement combined with contralateral mouth angle elevation was observed at approximately 9.5 months after the surgery.Conclusions:Our experience suggests that the distal stump of the intramuscular motor branch of the obturator nerve may be useful for facial reanimation via double-powered free gracilis muscle flap transfer.