|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
B. Four to six months later, when the Tinel sign reached the midcheek
area on the paralyzed side, the second stage of the operation is begun.
The serratus muscle in the upper portion of the diagram is free and ready
for insertion onto the paralyzed side of the face. The scapular origin of
the muscle will be sutured securely to the temporalis and zygomatic fascia.
The muscle is turned over so that the neurovascular pedicle now comes off
inferiorly and on the deep surface of the muscle, rather than superiorly
and on the superficial surface of the muscle, as it lies on the chest.
A 50-year-old woman underwent resection of a left acoustic neuroma, resulting in a left facial palsy.
FIG. 22-01. There is obvious slackness in the left face, and inability to close the eye has been symptomatic. Patient attempts to smile.
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