Facial paralysis that has been caused by trauma, tumour excision or congenital facial palsy, can be treated by dynamic muscle transfer. This is a two-stage reanimation procedure that involves grafting nerves from the side of the body that is unaffected by paralysis and crossing them over to the other side. It’s a very complex technique that allows your own natural nerve fibres to grow and develop on the affected side of the face.
What does dynamic muscle transfer entail?
The first stage of the dynamic muscle transfer is to take a nerve graft from the sural nerve located in the leg. The graft is placed in the unaffected side of the face, attaching it to the facial nerve. It is then passed over to the opposite, affected side. Over a three-month period, the axonal fibres begin to grow from the unaffected side of the face, over to the paralysed side. These can then be used as a successful nerve source for a free muscle flap.
After three months, the free muscle flap is inserted and that works to reproduce the facial movements that have been lost. The muscle is taken usually from either the thigh or the chest. Mr Paul Tulley then uses a microsurgical free transfer procedure to then insert it into the face. The nerve fibres that have grown over the first three months then start to grow into the muscle flap. It is these which help the flap to start moving to create facial expressions.