Division of Plastic and Reconstructive Surgery, Department of Surgery, Western University, and London Health Sciences Center, Victoria Hospital, London, ON, Canada.
J Plast Reconstr Aesthet Surg. 2012 Aug;65(8):1002-8. doi: 10.1016/j.bjps.2012.03.021. Epub 2012 Apr 2.
The pedicled masseter muscle transfer (PMMT) is introduced as a new reconstructive option for dynamic smile restoration in patients with facial paralysis. The masseter muscle is detached from both its origin and insertion and transferred to a new position to imitate the function of the native zygomaticus major muscle.
Part one of this study consisted of cadaveric dissections of 4 heads (eight sides) in order to determine whether the masseter muscle could be (a) pedicled solely by its dominant neurovascular bundle and (b) repositioned directly over the native zygomaticus major. The second part of the study consisted of clinical assessments in three patients in order to confirm the applicability of this muscle transfer. Commissure excursion and vector of contraction following PMMT were compared to the non-paralyzed side.
In all eight sides, the masseter muscles were successfully isolated on their pedicle and transposed on top of and in-line with the ipsilateral zygomaticus major. The mean length of the masseter and its angle from Frankfurt's horizontal line after transposition compared favorably to the native zygomaticus major muscle. In the clinical cases, the mean commissure movements of the paralyzed and normal sides were 7 mm and 12 mm respectively. The mean angles of commissural movement for the paralyzed and normal sides were 62° and 59° respectively.
The PMMT can be used as a dynamic reconstruction for patients with permanent facial paralysis. As we gain experience with the PMMT, it may be possible to use it as a first-line option for patients not eligible for free micro-neurovascular reconstruction.
带蒂咬肌肌皮瓣转移术（PMMT）作为一种新的重建选择，用于恢复面瘫患者的动态笑容。将咬肌从其起点和止点处分离，并转移到新的位置，以模拟正常颧大肌的功能。
本研究的第一部分包括 4 个头（8 侧）的尸体解剖，以确定咬肌是否可以（a）仅由其主要神经血管束带蒂，以及（b）直接重新定位到正常颧大肌上方。研究的第二部分包括对 3 例患者的临床评估，以确认这种肌肉转移的适用性。比较 PMMT 后的口角偏移和收缩向量与未瘫痪侧。
在所有 8 侧中，咬肌均成功地在其蒂上分离，并转移到同侧颧大肌的上方和线上。转移后咬肌的平均长度及其与法兰克福水平线的夹角与正常颧大肌肌肉相比具有优势。在临床病例中，瘫痪侧和正常侧的平均口角运动分别为 7mm 和 12mm。瘫痪侧和正常侧的口角运动平均角度分别为 62°和 59°。
PMMT 可作为永久性面瘫患者的动态重建方法。随着我们对 PMMT 的经验积累，它可能成为不符合游离显微血管重建适应证患者的一线选择。
