One-Stage Latissimus Dorsi Muscle Transfer for Facial Reanimation: Comparison Between Single and Dual Innervation

Abstract

One-stage latissimus dorsi neuromuscular transfer has distinct advantages and has become a viable option for dynamic smile reconstruction. A dual-innervation technique has emerged that supplies the transferred latissimus dorsi muscle with two neural inputs, the ipsilateral masseteric nerve and the contralateral facial nerve branch. This technique has the potential for rapid re-innervation of the transferred muscle, leading to strong contraction power and spontaneous smiling. Diverse techniques can be adopted for the dual innervation: coaptation of the thoracodorsal nerve stalk to the contralateral facial nerve branch in the conventional technique and direct neurorrhaphy between a transverse branch of the thoracodorsal nerve and the ipsilateral masseteric nerve. Generally favorable outcomes of the dual-innervation technique with theoretical benefits have been reported; however, the superiority of this technique over the conventional single-innervation technique has not been completely elucidated and requires further investigation.