Double innervation (facial/masseter) sur le lambeau gracile dans les réanimations du tiers moyen de la face lors de la prise en charge des paralysies faciales: Nouveau concept = Double innervation (facial/masseter) on the gracilis flap, in the middle face reanimation in the management of facial paralysis: A new concept

Introduction: The facial paralysis is a non-rare condition that has very disabling functional, morphological and psychological repercussions. The current gold standard in facial reanimation is revascularized re-innervated muscle transfers. Materials and methods: In this paper, we report the results of a new method using the gracilis flap with a double innervation on the masseter motor nerve and the controlateral facial nerve via a sural graft in a single stage intervention, on a series of six patients. Results: No failure was observed. The average delay of a voluntary contraction was 3.8. months, and 7.2. months for a spontaneous one. Three of the six patients had "excellent" results according to the Terzis and Noah classification, two were classified as "good" and one "average" Discussion: A choice is to be made between a method advocating a natural and spontaneous dynamicity (controlateral facial nerve stimulus) and a method focusing on the quality and quantity of contractions (ipsilateral trijeminal stimulus). In this new technique, we combine the two methods: a free gracilis transfer with a dual innervation on the healthy controlateral facial nerve via a sural graft, on one hand, and a second anastomosis on the ipsilateral masseter nerve, on the other hand. Conclusion: This new proposed method seems to be, according to our results, a reliable technique rallying voluntary contraction and emotional smile.La paralysie faciale est une pathologie non rare \ue0 retentissements fonctionnel, morphologique et psychologique tr\ue8s handicapants. Le gold standard actuel est la r\ue9animation faciale par les transferts musculaires revascularis\ue9s r\ue9-innerv\ue9s. Mate\ub4riel et me\ub4thodes. \u2014 Dans ce travail, on rapporte les r\ue9sultats d\u2019une nouvelle m\ue9thode utilisant le gracile avec double innervation sur le nerf mass\ue9ter et sur le facial controlat\ue9ral via une greffe nerveuse et ce en un seul temps op\ue9ratoire, sur une s\ue9rie de six patients. Re\ub4sultats. \u2014 Aucun \ue9chec n\u2019a \ue9t\ue9 not\ue9. Le d\ue9lai moyen d\u2019une contraction volontaire \ue9tait de 3,8 mois. Celui d\u2019une contraction spontan\ue9e \ue9tait de 7,2 mois. Trois parmi les six patients ont eu des r\ue9sultats \uab excellents \ubb selon la classification de Terzis et Noah, deux \ue9taient class\ue9s \uab bons \ubb et un seul \uab moyen \ubb. Discussion. \u2014 Le choix reste \ue0 faire entre une m\ue9thode pr\uf4nant une dynamique spontan\ue9e naturelle (\ue0 stimulus facial controlat\ue9ral) et une m\ue9thode misant sur la qualit\ue9 et la quantit\ue9 de contraction (\ue0 stimulus ipsilat\ue9ral trijeminal). Dans cette nouvelle technique, nous combinons les deux m\ue9thodes : un transfert gracile \ue0 double innervation sur le facial sain controlat\ue9ral via une greffe surale, d\u2019une part, et une deuxi\ue8me anastomose sur le nerf mass\ue9ter homolat\ue9ral, d\u2019autre part. Conclusion. \u2014 La nouvelle m\ue9thode propos\ue9e dans ce travail nous semble, selon nos r\ue9sultats obtenus, une technique fiable ralliant la contraction volontaire et le sourire \ue9motionnel