Acellular Dermal Matrix (AlloDerm) as an Adjunct in Reconstruction of Facial Paralysis
Roger L. Simpson, M.D.1, Jeffrey R. Ridha, MD2, Laurence T. Glickman, MD1, Thomas A. Davenport, MD1.
1Long Island Plastic Surgical Group, Garden City, NY, USA, 2Nassau University Medical Center, East Meadow, NY, USA.
The use of cryopreserved acellular dermal matrix (AlloDerm) in reconstructive procedures has gained popularity. Patients undergoing dynamic reanimation for complete facial paralysis require procedures including contiguous muscle transfer, lower eyelid suspension, and lip augmentation. Temporalis muscle transfer requires use of a prosthetic implant to contour the muscle defect. Eyelid suspension requires a fascial sling for sustained vertical support. The lower lip requires filler injections to augment the atrophic orbicularis contour. AlloDerm offers a reliable method of soft tissue fill and support, with a decreased rate of complications and a reduced need for secondary procedures.
Over a five-year period, 35 patients undergoing facial reanimation had insertion of AlloDerm for ancillary procedures. Following temporalis transfer for dynamic reanimation, folded AlloDerm filled the donor muscle defect, in place of prosthesis for contour. A strip of AlloDerm was used as a suspensory sling for vertical support in the paralyzed lower eyelid. Multiple strips of AlloDerm were inserted into the upper and lower atrophic orbicularis oris to increase fullness and decrease drooling.
Patients, at six month intervals postoperatively, were assessed for function, appearance, and need for secondary procedures. The temporalis donor area was assessed for contour and pain, the lower lid slings for corneal protection and residual ectropion, and the lips for volume, saliva loss, and appearance. Follow-up ranged from one to five years, with all patients returning for evaluation.
Surgical procedures with AlloDerm showed favorable outcomes. Fifteen patients had AlloDerm placed for temporalis muscle defects; six of those underwent placement after prior implants developed capsule deformity and pain. Three patients required minor revisions. All 15 patients have maintained a natural contour with no clinical AlloDerm resorption. None reported pain or tenderness at the site. One patient extruded a small portion of the AlloDerm with uncomplicated progressive closure and no loss of the implant volume.
Five patients underwent placement of AlloDerm for lower eyelid suspension. One patient required a cartilage graft for lid support. In the other four patients, the eye has remained protected with no evidence of recurrent ectropion.
Twenty-five patients were treated with AlloDerm for paralytic lip atrophy. Twenty one maintained good contour, showing only a minor degree of resorption at 24 months. Four required a secondary placement for significant resorption of AlloDerm before 24 months. There were no infections or other indications for AlloDerm removal.
AlloDerm is a safe and useful adjunct in patients undergoing facial paralysis reanimation. Decreased morbidity is appreciated at the donor muscle area compared to results of solid implant placement. A comfortable and natural contour was produced. Lower eyelid functional support is achieved without the need for harvested fascia, with no clinical evidence of absorption or subsidence present. AlloDerm fill of the atrophic portions of the upper and lower lips provided more consistent fill contours than either fat or injectable filler. AlloDerm has proved to be a reliable tissue, with results in facial paralysis comparable or better than current outcomes using prostheses, autogenous fascia, and injectables.