The sternohyoid muscle flap for new dynamic facial reanimation technique: Anatomical study and clinical results

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 74; no. 11; pp. 3040 - 3047
• Main Authors: Suñé, Carmen Higueras, López, Cristian Carrasco, López, Paloma Malagón, Senosiain, Oihane García, Escribano, María Del Río, Poyatos, Jordi Vilà, Barceló, Lia Huesa, Alcázar, Àngels Ribera, Carrera-Burgaya, Ana, De la Torre, Francisco Reina, Martínez-Piñeiro, Alicia, Cabezas, Emili Amilibia
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01-11-2021
• Subjects: Facial paralysis; Facial reanimation; Reinnervation; Sternohyoid muscle; Reinnervation; Sternohyoid muscle; Facial reanimation; Facial paralysis
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2021.03.085

Long-term facial nerve palsy has a highly negative impact on patients’ quality of life. In 2016, Alam reported one case of facial reanimation with the sternohyoid muscle after publishing a preclinical study in 2013. Despite the potentially ideal characteristics of this muscle for reanimation of facial palsy, this technique is still not widely used. The objective of our description of cases was to present the clinical results obtained with the surgical procedure and the study on cadavers to confirm the anatomical findings.
This work describes the anatomical study of the vascular and nervous pedicle of the sternohyoid muscle compared with clinical results from a series of patients with long-term facial paralysis who underwent facial reanimation between June 2016 and September 2019, through the insertion of the sternohyoid muscle into the masseteric nerve.
The anatomical study was conducted in eight human hemi-necks. In five cases (62%), the vascular pedicle was provided by the superior thyroid artery, and the entrance of the ansa cervicalis to the muscle was constant 1.8 cm from the distal insertion. This series included ten patients who underwent the surgery technique of facial reanimation using the sternohyoid muscle, with a 90% (n = 9) of reinnervation; 100% (n = 10) of flaps were viable, and none of the patients showed complications in the donor area.
The sternohyoid muscle showed itself as a reliable muscle as a free flap in facial reanimation, and alternative to the gracilis flap. The surgical technique was safe, without any complications, with excellent excursion, recovery, and aesthetic results.