One-stage reconstruction for bilateral Möbius syndrome: simultaneous use of bilateral spinal accessory nerves to innervate 2 free muscles for facial reanimation.
BACKGROUND
Möbius syndrome (MS) can present with unilateral or bilateral facial paralysis. In performing 1-stage bilateral MS facial reanimation, we used bilateral spinal accessory (XI) nerves to innervate 2 free functional muscle transfers (FFMTs).


METHODS
Of 12 MS patients, 6 had bilateral facial paralysis. Bilateral gracilis were transferred and innervated using bilateral XI nerves. Results were evaluated using smile excursion score, cortical adaptation stage, and patient satisfaction questionnaire.


RESULTS
In all, 13 FFMTs were performed (with 1 gracilis failure). Mean smile excursion score improved from 0.7 to 3.4 (out of 5) postoperatively. Four patients achieved spontaneous smile, 1 achieved independent smile, and 1 achieved dependent smile. Mean satisfaction score was 2.8 (out of 5).


CONCLUSIONS
One-stage bilateral FFMTs neurotized by bilateral XI nerves are effective in treating bilateral MS patients. Careful patient selection, adequate neurologic and psychologic examination, and postoperative smile training are all important factors in achieving optimal outcomes.
Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
Johnny Chuieng-Yi
JC
Lu
David Chwei-Chin
DC
Chuang
D000055:Accessory Nerve / Q000637:transplantation*; D000293:Adolescent; D002675:Child, Preschool; D005149:Facial Expression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020331:Mobius Syndrome / Q000601:surgery*; D018482:Muscle, Skeletal / Q000294:innervation* / Q000637:transplantation*; D016067:Nerve Transfer / Q000379:methods*; D055815:Young Adult