Craniofacial Muscles

15 Facial Nerve Innervation and Facial Palsies
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As with unilateral reconstructions there is variation in the choice of donor muscle,
which can be in fl uenced further by any peripheral involvement of the patient’s
underlying syndrome.
We utilize the masseteric branch of the trigeminal nerve to power a segmental section
of latissimus dorsi. We alter the muscle donor from our unilateral reconstructions as
the length of nerve required to perform a neurorraphy within the muscle bulk of
masseter cannot be provided by pectoralis minor. Gracilis has a long enough pedicle
and in bilateral cases its excess bulk is less distracting due to its symmetry (Zuker
et al. 2000 ) . We prefer to operate in a single stage in children under 10 years of age
as this drastically reduces the overall recovery time, and we believe the plasticity of
the brain in this age group allows them to adapt and learn to smile spontaneously in
response to emotion (Woollard et al. 2010 ) .
15.11 Summary
The muscles innervated by the facial nerve have a very different function from
those of the axial skeleton. They facilitate the sophisticated and subtle ballet of
facial expression and communication, a vital part of human social interaction. They
provide protection to the eye and dentition. The movement and tone of the lips
allow for oral continence, clarity of speech, and of course smiling. These actions
comprise an interaction of many small muscles of variable strengths and vectors
acting in concert, perhaps rivaled only by the movements of the hand. Reconstruction
of a de fi cit in this nerve–muscle complex is still a crude science, and one in which
it is hard to remain faithful to Gilles maxim of replacing “like with like.” However,
its importance to a patient’s quality of life cannot be underestimated.
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