Skip to main content
AAO-HNSF 2023 Annual Meeting & OTO Experience Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Back
Rate ePoster

Facial Plastic and Reconstructive Surgery

(461) Sterno-omohyoid Muscle Transfer for Smile Reanimation in Congenital Facial Palsy

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Elizabeth Huuki

    Medical Student
    The Uniform Service University of the Health Science
    BETHESDA, Maryland, United States

    • Co-Author(s)

  • Jessica L. Lewis-Cruz, MD

    PGY-1
    Madigan Army Medical Center
    Tacoma, Washington, United States

    • Senior Author(s)

  • JK

    Joseph S. Krivda, MD

    Madigan Army Medical Center, USA

  • KA

    Kelly G. Anderson, MD

    Head and Neck Surgery and Microvascular Reconstruction
    Tripler Army Medical Center
    Honolulu, Hawaii, United States

  • MH

    Marc W. Herr, MD

    Head & Neck Surgeon
    Madigan Army Medical Center
    Tacoma, Washington, United States

  • AV

    Aurora G. Vincent, MD

    Deputy Chief of Surgery
    Eisenhower Army Medical Center
    Fort Gordon, Georgia, United States

  • MH

    Marc H. Hohman, MD

    Associate Professor
    Madigan Army Medical Center
    Tacoma, Washington, United States

Disclosure(s):
Elizabeth Huuki: No relevant relationships to disclose.
Jessica L. Lewis-Cruz, MD: No relevant relationships to disclose.
Kelly G. Anderson, MD: No relevant relationships to disclose.
Marc W. Herr, MD: No relevant relationships to disclose.
Aurora G. Vincent, MD: No relevant relationships to disclose.
Marc H. Hohman, MD: No relevant relationships to disclose.


Introduction: A 38 year old female presented with right congenital facial palsy, interested in smile improvement. A novel procedure, sterno-omohyoid free muscle transfer, was performed in an effort to provide a dual-vector smile without introducing additional bulk into the face.

Methods: A sterno-omohyoid flap was transferred from the right neck to the face. The omohyoid replaced the levator labii superioris and the sternohyoid the zygomaticus major. One pedicle supported both muscles. The ansa cervicalis was sewn to both the masseteric nerve and a cross-face nerve graft. The superior thyroid artery and vein were coapted to the facial vessels. An eyelid weight and fascia sling to the nasolabial fold were also placed.

Outcomes were assessed using the Facial Clinimetric Evaluation Scale (FaCE), eFACE app-based grading system, and Emotrics facial measurement software. The FaCE scale is a validated self-assessment of the impact of facial paralysis on quality of life. The eFACE is a scale that measures individual facial features and regional function at rest and with voluntary and involuntary movement. Smile, static, dynamic, and midface-smile domains were selected for analysis, because they were the areas most likely to be affected by the procedure performed. Emotrics is an automated measurement app that compares facial landmark positions and symmetry at rest and with movement, before and after surgery.

Results: The flap weighed 15 g; movement was first seen at 3 months and the patient was followed for 24 months. The FaCE score improved by 37 points. The eFACE smile domain improved by 13 points, static by 25 points, dynamic by 14 points, and midface-smile by 29 points. Emotrics indicated resting oral commissure symmetry improved by 7.1 mm, smile excursion by 7.5 mm, smile symmetry by 7.7 mm, and smiling dental show by 5.7 mm.

Conclusions: The sterno-omohyoid flap was used successfully for reanimation in congenital facial palsy, producing a natural, dual-vector smile with dental show. Additional cases are needed to detail the advantages of this technique relative to traditional reanimation, particularly regarding smile spontaneity.