Triple nerve transfers for the management of early unilateral facial palsy.

Background: Early onset facial paralysis is usually managed with cross-face nerve grafts, however the low number of axons that reach the target muscle may result in weakness or failure. Multiple-source innervation, or 'supercharging', seeks to combine the advantages of different donor nerves while minimizing their weaknesses. We propose a combination of cross-face nerve grafts with local extra-facial nerve transfers to achieve earlier facial reanimation in our patients.

Dynamic reanimation of severe blepharoptosis using the neurotized omohyoid muscle graft.

Background: Attempts at dynamic reconstruction of the upper eyelid either by neurotization or direct muscle replacement have been scarce. Substitution of the levator palpebrae superioris muscle requires the use of extremely small and pliable structures. As a proof of concept/pilot study, we present a consecutive series of patients who underwent blepharoptosis correction using the neurotized omohyoid muscle graft.

Facial paralysis, etiology and surgical treatment in a tertiary care center in plastic and reconstructive surgery in Mexico.

Background: Facial paralysis is a frequent disabling entity that causes a negative impact on the cosmetic, functional, social, psychological and economic aspects of the patient. Surgical treatment aims to restore the patient to her previous life with the fewest possible sequelae.

Objective: Describe the experience of surgical management and propose a treatment algorithm.

Lower extremity nerve injuries and their management at a referral center in Mexico City.

Objetivo: Describir el manejo de las lesiones nerviosas de extremidad inferior atendidas en un centro de referencia en cirugía plástica y reconstructiva en la Ciudad de México.

MÉtodo: Estudio descriptivo, transversal y retrospectivo, en el que se evaluaron los expedientes clínicos de pacientes atendidos por lesiones nerviosas de extremidad inferior entre 2010 y 2018.

Resultados: Se incluyeron 21 pacientes, 14 hombres (66.

Prevalence of Hand Malformations in Patients With Moebius Syndrome and Their Management.

Background: Moebius syndrome is a disorder characterized by facial and abducens nerve paralysis. Patients can present a wide range of upper extremity malformations. Literature focused on orthopedic manifestations of Moebius syndrome shows variability in the prevalence and clinical presentation of upper extremity anomalies.

Cephalometric Analysis of the Craniofacial Morphology in Patients With Moebius Syndrome.

Background: Patients with Moebius syndrome may present a wide range of associated orofacial malformations, however, their craniofacial morphology has not been established via controlled cephalometric studies.

Objective: To present our institution's findings in the cephalometric evaluation in patients with Moebius syndrome.

Methods: Retrospective, cross-sectional study that included patients with Moebius syndrome over 9 years of age who had lateral cephalometric radiographs.

Diagnosis and treatment of speech disorders in children with Moebius syndrome.

Background: Moebius syndrome (MS) is characterized by congenital bilateral paralysis of the facial and abducens nerves. Clinical features include feeding problems, dysarthria, dysphagia, sialorrhea, strabismus, and lack of facial expression. Patients with MS frequently present with dysphagia during infancy.

Changes in Electrical Activity of the Masseter Muscle and Masticatory Force after the Use of the Masseter Nerve as Donor in Facial Reanimation Surgery.

 The masseter nerve has been used as a donor nerve for facial reanimation procedures due to the multiple advantages it offers; it has been generally considered that sacrifice of the masseter nerve does not alter the masticatory apparatus; however, there are no objective studies to support this claim.  To evaluate the impact that the use of the masseter nerve in dynamic facial reconstruction has on the electrical activity of the masseter muscle and on bite force.  An observational and prospective longitudinal study was performed measuring bite force and electrical activity of the masseter muscles before and 3 months after dynamic facial reconstructive surgery using the masseter nerve.

Electromyographic evaluation of the facial and motor donor nerves before facial reanimation surgery in Moebius syndrome.

Background: Moebius syndrome is a clinical entity characterized by bilateral facial and abducens nerve palsies; other cranial nerver might be affected as well. So far, no studies have reported the electromyographic responses of the facial musculature in this group of patients.

Objective: The objective of our study is to describe the electromyographic responses of the facial muscle and the main donor nerves for facial reanimation in patients with Moebius syndrome.

Difficult Airway Identification and Management in Patients With Moebius Syndrome.

Background: Airway management in patients with Moebius syndrome can be difficult due to the presence of orofacial malformations. This paper aims to present our institution's experience in the evaluation and management of the upper airway in patients with Moebius syndrome METHODOLOGY:: The authors performed a retrospective study including every patient with Moebius syndrome submitted to surgery between 2012 and 2017. Difficult airway was defined as one requiring more than 2 attempts to achieve endotracheal tube placement, a Mallampati score equal or above III, a Cormack score equal or above III, or need of a fiberscope during intubation.

Bite force and electromyographic activity of the masseter muscle in children with hemifacial microsomia.

Hemifacial microsomia (HFM) is a malformation characterized by asymmetric facial growth with mandibular and muscular involvement. There are no reports focused on the functional status of the masticatory system of patients with HFM. The objective of this work evaluate bite force and electrical activity of masseter muscle in children with HFM, and compare them to healthy controls.

An International Collaborative Standardizing Patient-Centered Outcome Measures in Pediatric Facial Palsy.

Importance: Standardization of outcome measurement using a patient-centered approach in pediatric facial palsy may help aid the advancement of clinical care in this population.

Objective: To develop a standardized outcome measurement set for pediatric patients with facial palsy through an international multidisciplinary group of health care professionals, researchers, and patients and patient representatives.

Design, Setting, And Participants: A working group of health care experts and patient representatives (n = 21), along with external reviewers, participated in the study.

[Implementation of intraoperative neurophysiologic monitoring in children and adults in secondary and tertiary health care facilities].

Introduction: Intraoperative neurophysiological monitoring (IONM) is a procedure that uses neurophysiological techniques in order to evaluate the motor and sensitive systems during surgeries that endanger the nervous system.

Method: The approach, scope, target population, and clinical questions to be answered were defined. A systematic search of the evidence was conducted step by step; during the first stage, clinical practice guidelines were collected, during the second stage systematic reviews were obtained, and during the third stage, clinical trials and observational studies were procured.

Facial Reanimation in the Seventh and Eighth Decades of Life.

Background: Treatment of facial paralysis in the older population is often relegated to static rather than dynamic reanimation for fear of poor outcomes. This pervasive approach lacks physiologic foundation and is not evidence based. Thus, the authors present an extensive literature review demonstrating weak evidence supporting this misguided concept, followed by detailed outcomes from three centers of the largest reported series to date of patients older than 60 years after reanimation performed using three techniques-lengthening temporalis myoplasty, free functional muscle, and nerve transfers.

Surgical Resection of Vascular Lesions Involving the Buccal Fat Pad.

Vascular abnormalities are localized structural irregularities, which are performed during vasculogenesis, angiogenesis, and lymphangiogenesis. The involvement of soft tissue in such vascular malformations is frequent; however, the compromising of the buccal fat pads (Bichat bags) is uncommon, even in specialized centers, such as the plastic clinic of our institution, in which very few patients have been reported in the literature. The purpose of this article is to present a series of 2 patients in which vascular malformations involving the buccal fat pads, which were extracted by intraoral approach.

Levator Palpebrae Superioris Muscle Direct Neurotization.

Direct muscle neurotization has been proved to be a feasible technique for facial reanimation microsurgical procedures. Direct muscle neurotization is performed by implanting the interposition nerve graft directly into the substance of the muscle. The authors present the case of a 36-year-old male patient with upper eyelid dysfunction secondary to facial trauma.

Upper Extremity Patterns of Injury and Management at a Plastic and Reconstructive Surgery Referral Center in Mexico City.

Background: Acute upper extremity injuries remain one of the most common consultations in the emergency departments for plastic surgery services. These injuries can affect a person's quality of life and negatively affect work-related or social interactions if not properly managed. We aim to evaluate our experience and management in a specialized referral center in Mexico City.

The Deep Temporal Nerve Transfer: An Anatomical Feasibility Study and Implications for Upper Facial Reanimation.

Background: Facial paralysis has a profound impact on the brow, and currently static procedures are the mainstay of treatment. The deep temporal branches of the trigeminal nerve, given their proximity to the brow, may serve as possible donor nerves for both potential innervation of a free muscle transfer in patients with prolonged facial palsy or nerve transfers in acute or subacute palsy. As such, the authors present the detailed surgical anatomy of the deep temporal nerve, assessing feasibility for both functional muscle and nerve transfers, including a proposed surgical technique.

Nerve Transfer for Facial Paralysis Under Intravenous Sedation and Local Analgesia for the High Surgical Risk Elderly Patient.

Background: This case report describes an 86-year-old woman with complete peripheral right-sided facial paralysis resulting from resection of a cervical lipoma 14 months before surgery.

Case Description: Because of the high anesthetic risk, a masseter to facial nerve transfer was performed under combined light sedation and local anesthetic. Good functional and aesthetic outcomes were noted without complications.

Double innervated free functional muscle transfer for facial reanimation.

Background: The treatment of long-standing facial palsy represents a challenge for the reconstructive surgeon. Treatment is based on dynamic procedures such as functional muscle flaps. The benefit of added axonal load has recently been reported.

Negative pressure wound therapy in preseptal orbital cellulitis complicated with necrotizing fasciitis and preseptal abscess.

Purpose: Preseptal cellulitis (PC) may be locally complicated with abscess formation and necrotizing fasciitis. If not treated promptly and adequately, it may result in further complications. The authors report a series of patients where negative pressure wound therapy (NPWT) proved a safe and valuable adjunct therapy in avoiding complications of PC and in accelerating wound healing.

Keloid skin scars: the influence of hyperbaric oxygenation on fibroblast growth and on the expression of messenger RNA for insulin like growth factor and for transforming growth factor.

Wound healing can result in the development of keloid scars that contain atypical fibroblasts and an overabundance of extracellular matrix components. Hyperbaric oxygenation (HBO) refers to exposure to pure oxygen under increased atmospheric pressure and is recognized as a valuable supplementary method of treatment for problematic wounds. The effect of HBO in the expression of insulin-like growth factor type 1 (ILGF-1) and transforming growth factor β (TGF-β) messenger RNAs was determined by semiquantitative RT-PCR in fibroblasts obtained from keloid scars and nonwound involved skin fibroblast from the same patient.

Surgical strategies to salvage the venous compromised deep inferior epigastric perforator flap.

Background: Elevation of the deep inferior epigastric perforator (DIEP) flap interrupts its superficial venous system, and if drainage through the deep venous system is inadequate the flap may develop congestion. The purpose of this retrospective study was to determine the fate of the congested DIEP flap and to optimize the strategy for its salvage.

Methods: Thirty-two of 162 patients who underwent unilateral breast reconstruction with a DIEP flap developed venous congestion.