Neuroanatomy of Extensor Digitorum Brevis Muscle for Reanimation of Facial Paralysis

PurposeThis study explores the vascular and morphologic anatomy of extensor digitorum brevis (EDB), which can be alternatives to donor muscles used in functional muscle transfer in long-standing facial paralysis reanimation. MethodsA total of 14 EDB muscles from 7 embalmed cadavers were dissected and examined. Diameters and lengths of major and minor arteries supplying the muscle, venous pedicle diameter, neural pedicle diameter and length, their entrances into the muscle, the extendibility of neurovascular pedicles, when necessary, and the morphology of muscles were evaluated. ResultsMean results obtained for EDB muscle in the study were as follows: the longest distance between the starting point and the area where the tendon started was a mean of 5.1 ± 0.1 cm (range, 4.8–5.4 cm), the distance between the widest points was 4.2 ± 0.3 cm (range, 3.7–4.9 cm), the thickest area was 1.4 ± 0.8 cm (range, 1–1.9 cm), and surface area was a mean of 32.1 ± 1.2 cm2 (range, 29.8–35.7 cm2). The mean length of the major artery is type 2 according to Mahtnes-Nahai classification and was found to be 2.1 ± 0.03 cm (range, 1.6–3.2 cm), and its diameter was found to be 1.95 ± 0.15 mm (range, 1.7–2.1 mm). Mean length and diameter of the nerve providing motor innervation to the muscle were found to be 2.3 ± 0.03 cm (range, 2.1–2.6 cm) and 2.4 ± 0.08 mm (range, 2–2.9 mm), respectively. ConclusionAs a result of this preliminary study, we think that the morphologic and neurovascular structures of this muscle are suitable for use in long-standing facial paralysis reanimation.

[1]  A. Comert,et al.  The Utilization of Teres Major Muscle in Facial Paralysis Reanimation: An Anatomic Study , 2009, The Journal of craniofacial surgery.

[2]  J. VanSwearingen,et al.  One-Stage Reanimation of the Paralyzed Face Using the Rectus Abdominis Neurovascular Free Flap , 2006, Plastic and reconstructive surgery.

[3]  A. Hayashi,et al.  Neurovascularized Free Short Head of the Biceps Femoris Muscle Transfer for One-Stage Reanimation of Facial Paralysis , 2005, Plastic and reconstructive surgery.

[4]  K. Fukumoto,et al.  Indication and Practice of Reverse Flow Extensor Digitorum Brevis Muscle Flap Transfer , 2003, Annals of Plastic Surgery.

[5]  G. I. Taylor,et al.  Comparative Anatomical Study of the Gracilis and Coracobrachialis Muscles: Implications for Facial Reanimation , 2003, Plastic and reconstructive surgery.

[6]  Jiasheng Dong,et al.  Neurovascular Musculus Obliquus Internus Abdominis Flap Free Transfer for Facial Reanimation in a Single Stage , 2002, Plastic and reconstructive surgery.

[7]  James E Benecke.  Facial paralysis. , 2002, Otolaryngologic clinics of North America.

[8]  G. Lin,et al.  Extensor digitorum brevis rotational muscle flap for lower leg and ankle coverage. , 2000, The Journal of trauma.

[9]  F. del Piñal,et al.  Extensor Digitorum Brevis Free Flap: Anatomic Study and Further Clinical Applications , 2000, Plastic and reconstructive surgery.

[10]  Y. Chuan,et al.  Free split and segmental latissimus dorsi muscle transfer in one stage for facial reanimation. , 1999, Plastic and reconstructive surgery.

[11]  T. Nakatsuka,et al.  One‐Stage Transfer of the Latissimus Dorsi Muscle for Reanimation of a Paralyzed Face: A New Alternative , 1998, Plastic and reconstructive surgery.

[12]  E. Demiri,et al.  Extensor Digitorum Brevis Muscle Flap: New Refinements , 1998, Plastic and reconstructive surgery.

[13]  V. Meyer,et al.  The Extensor Digitorum Brevis Island Flap: Possible Applications Based on Anatomy , 1998, Plastic and reconstructive surgery.

[14]  N. Martin-Duverneuil,et al.  [Peripheral facial paralysis]. , 1997, Journal of neuroradiology. Journal de neuroradiologie.

[15]  I. Koshima,et al.  One-stage reconstruction of established facial paralysis using a rectus abdominis muscle transfer. , 1997, Plastic and reconstructive surgery.

[16]  P. A. Kumar,et al.  Cross-face reanimation of the paralysed face, with a single stage microneurovascular gracilis transfer without nerve graft: a preliminary report. , 1995, British journal of plastic surgery.

[17]  K. Harii,et al.  Free combined parascapular flap and latissimus dorsi muscle flap for facial palsy and neck reconstruction. , 1995, British journal of plastic surgery.

[18]  K. Hosokawa,et al.  Treatment of chronic facial palsy by transplantation of the neurovascularized free rectus abdominis muscle. , 1990, Plastic and reconstructive surgery.

[19]  B. O'brien,et al.  Results of Management of Facial Palsy with Microvascular Free‐Muscle Transfer , 1990, Plastic and reconstructive surgery.

[20]  M. Jaquith,et al.  The extended digitorum brevis muscle flap. , 1989, Annals of plastic surgery.

[21]  J. Terzis.  Pectoralis minor: a unique muscle for correction of facial palsy. , 1989, Plastic and reconstructive surgery.

[22]  C. Argenson,et al.  Extensor Digitorum Brevis as an Island Flap in the Reconstruction of Soft‐Tissue Defects in the Lower Limb , 1989, Plastic and reconstructive surgery.

[23]  A. Landi,et al.  The extensor digitorum brevis muscle island flap for soft-tissue loss around the ankle. , 1985, Plastic and reconstructive surgery.

[24]  D. Harrison.  The Pectoralis Minor Vascularized Muscle Graft for the Treatment of Unilateral Facial Palsy , 1985, Plastic and reconstructive surgery.

[25]  L. Ketch.  Clinical Applications for Muscle and Musculocutaneous Flaps , 1983 .

[26]  R. Acland,et al.  The Microarterial Anatomy of the Dorsalis Pedis Flap and Its Clinical Applications , 1980, Plastic and reconstructive surgery.

[27]  B. O'brien,et al.  Cross-facial nerve grafts and microneurovascular free muscle transfer for long established facial palsy. , 1980, British journal of plastic surgery.

[28]  K. Harii,et al.  Microneurovascular free muscle transplantation for reanimation of facial paralysis. , 1979, Clinics in Plastic Surgery.

[29]  K. Harii,et al.  FREE GRACILIS MUSCLE TRANSPLANTATION, WITH MICRONEUROVASCULAR ANASTOMOSES FOR THE TREATMENT OF FACIAL PARALYSIS: A Preliminary Report , 1976, Plastic and Reconstructive Surgery.

[30]  E. F. Worthen.  REGENERATION OF THE SKULL FOLLOWING A DEEP ELECTRICAL BURN , 1971, Plastic and reconstructive surgery.

[31]  N. Thompson.  AUTOGENOUS FREE GRAFTS OF SKELETAL MUSCLE: A Preliminary Experimental and Clinical Study , 1971, Plastic and reconstructive surgery.