Surface anatomy of the middle division of the facial nerve: Zuker's point.

Background: The anatomy of the facial nerve and its branches has been well documented. The course of the extratemporal facial nerve, its anatomical planes, and the surface landmarks of the temporal division and marginal mandibular division are well known. However, the surface landmark of the middle division of the facial nerve has not been studied to date.

Facial palsy and reconstruction.

This article outlines a thorough approach to facial nerve palsy and reconstruction.

Selective fascicular coaptation of free functioning gracilis transfer for restoration of independent thumb and finger flexion following Volkmann ischemic contracture.

Children are prone to developing moderate to severe Volkmann ischemic contracture following a supracondylar fracture of the humerus or its treatment. Given the variable extent of forearm muscle damage, tendon transfers and tenodeses are often unavailable. To address these contractures, intensive hand therapy and a free functioning muscle transfer are required.

Facial paralysis measurement with a handheld ruler.

Background: Evaluation of the severity of facial paralysis deformity and the effectiveness of reconstructive surgery requires a measurement tool that is practical and simple enough for daily use. It should be able to objectively measure facial asymmetry at rest and the amount of facial movement during expression. The authors present and assess a simple measurement technique that is readily usable in the clinic.

Introduction of microsurgery in Vietnam by a charitable organization: a 15-year experience.

Background: Microsurgical procedures, although equipment- and labor-intensive, allow efficient treatment of selected soft-tissue, bone, and peripheral nerve defects. The precise surgical skills required and the high equipment and institutional costs have been deterrents to initiating programs in developing countries. The authors report their 15-year international effort in facilitating the development of microsurgical techniques in Vietnam.

Functioning free muscle transfers.

Functioning free muscle transfer to the upper extremity is an extremely complex and difficult procedure. It is useful only in selected cases that require significant skeletal muscle replacement and fulfill stringent criteria. The operation itself is performed by means of a two-team approach.

Smile reconstruction in adults with free muscle transfer innervated by the masseter motor nerve: effectiveness and cerebral adaptation.

Background: This study assesses the ability of the masseter motor nerve-innervated microneurovascular muscle transfer to produce an effective smile in adult patients with bilateral and unilateral facial paralysis.

Methods: The operation consists of a one-stage microneurovascular transfer of a portion of the gracilis muscle that is innervated with the masseter motor nerve. The muscle is inserted into the cheek and attached to the mouth to produce a smile.

A comparison of commissure excursion following gracilis muscle transplantation for facial paralysis using a cross-face nerve graft versus the motor nerve to the masseter nerve.

Background: The microneurovascular transfer of a free muscle transplant is the procedure of choice for facial animation in a child with facial paralysis. One of the critical factors of this procedure is the selection of a motor nerve to innervate the transplanted muscle.

Methods: From 1989 to 1999, 166 free segmental gracilis muscle transfers were performed in 121 children for facial animation.

The use of local anesthetic motor block to demonstrate the potential outcome of depressor labii inferioris resection in patients with facial paralysis.

Background: If a patient with unilateral facial paralysis has marked depressor activity on the normal side, the appearance of the lower lip when smiling is asymmetrical. Defunctioning the muscle on the contralateral side to the palsy can restore balance. This can be achieved by resecting a portion of the depressor labii inferioris muscle on the nonparalyzed side.

Evaluation of a new measurement tool for facial paralysis reconstruction.

Evaluation of facial movement, including distance and direction, is essential for anyone interested in facial paralysis reconstruction. The authors' goal was to develop a measurement system that is simple, uses commercially available equipment, takes little time, and provides meaningful and accurate measurements. This technique is called the facial reanimation measurement system.

Carpal tunnel syndrome: cross-sectional and outcome study in Ontario workers.

Purpose: To carry out an analytic cross-sectional study of Ontario workers with carpal tunnel syndrome (CTS) and to assess workers' symptoms, functional disabilities, recreational difficulties, and work capability 4 years after treatment of their CTS.

Methods: Data were obtained by review of Ontario Workers Safety and Insurance Board (WSIB) files and by completion of self-assessment questionnaires. Inclusion criteria included all workers registered with the Ontario WSIB who were off work with newly diagnosed carpal tunnel syndrome in 1996.

Möbius syndrome.

Möbius syndrome is classically defined as combined congenital bilateral facial and abducens nerve palsies, although it may also be associated with a myriad of other craniofacial, musculoskeletal, cardiothoracic, endocrinologic, and developmental disorders. The problem that most patients complain about, however, is the inability to smile and close their lips while eating. Although the etiology of this syndrome is still unknown, scientific support has been growing for the hypothesis that it is due to an embryological disruption of subclavian artery development.

Plasticity of the human motor system following muscle reconstruction: a magnetic stimulation and functional magnetic resonance imaging study.

Objective: Although motor system plasticity in response to neuromuscular injury has been documented, few studies have examined recovered and functioning muscles in the human. We examined brain changes in a group of patients who had a muscle transfer.

Methods: Transcranial magnetic stimulation (TMS) was used to study a unique group of 9 patients who had upper extremity motor function restored using microneurovascular transfer of the gracilis muscle.

The effects of gracilis muscle transplantation on speech in children with Moebius syndrome.

Speech and communication are major problems for children with Moebius syndrome, a congenital anomaly that includes facial and abducens nerve paralysis and, often, other cranial nerve deficits. In addition, these children frequently have severe functional problems such as drooling as well as poor self-esteem. The purpose of this study was to investigate the outcome of speech with bilateral gracilis muscle transplants innervated by the masseteric nerve in children with Moebius syndrome.

Tendon function after replantation: prognostic factors and strategies to enhance total active motion.

The purpose of this study was to determine the important prognostic factors for recovery of tendon function as measured by total active movement (TAM) in patients undergoing digital replantation. More important, the authors wanted to establish which factors may be manipulated to maximize motion. A retrospective review of 48 patients (103 digital rays) who underwent replantation was performed.