Dynamic Muscle Transfer in Facial Nerve Palsy: The Use of Contralateral Orbicularis Oculi Muscle

The aim of the study is to describe the results of dynamic muscle transfer with an orbicularis oculi muscle flap from the contralateral side to the paralyzed side in patients with House-Brackmann grade 6 facial nerve palsy. This case series included six patients who underwent dynamic muscle transfer with a flap of healthy orbicularis oculi muscle fibers from the contralateral side into the paralyzed orbicularis oculi muscle. All patients had a House-Brackmann grade 6 facial nerve palsy. They all had previous multiple surgical procedures to improve the eyelid function. In spite of this, they were all symptomatic in terms of corneal exposure before orbicularis muscle transfer. All patients had postoperative follow up in excess of 2 years after the procedure. All patients improved symptomatically and had clinically reduced lagophthalmos postoperatively. Five patients who had an absent blink reflex showed a significant improvement in their blink reflex postoperatively. No complications occurred at the donor site. All patients showed a significant improvement of their symptoms and their lagophthalmos reduced postoperatively. Most importantly, the blink occurred involuntarily at the same time as the blink on the normal side. The authors propose that a dynamic muscle transfer using the contralateral orbicularis muscle may be considered to improve the voluntary lid closure and spontaneous blink reflex to improve corneal exposure in patients with grade 6 facial palsy who have not benefited from conventional surgical procedures.