Endoscopic dissection of recipient facial nerve for vascularized muscle transfer in the treatment of facial paralysis  Akihiko Takushima, Kiyonori Harii, Hirotaka Asato  British Journal of Plastic Surgery  Volume 56, Issue 2, Pages 110-113 (March 2003) DOI: 10.1016/S0007-1226(03)00042-0

Fig. 1 Two incisions are placed on the pre-auricular region of the non-paralyzed side. From each incision, the SMAS plane is dissected blind as the dotted lines indicate. British Journal of Plastic Surgery 2003 56, 110-113DOI: (10.1016/S0007-1226(03)00042-0)

Fig. 2 After the right-handed surgeon introduces an endoscope through the left incision, dissection is continued using a microdissector inserted through the right incision. The pre-auricular skin is hooked, and adjunctive traction of the cheek skin is performed using 3–0 silk thread, since sufficient optic space cannot be attained. British Journal of Plastic Surgery 2003 56, 110-113DOI: (10.1016/S0007-1226(03)00042-0)

Fig. 3 Endoscopic dissection enables visualization of several facial nerve branches. Among these branches, those innervating the zygomaticus major muscle can be found by dissecting the undersurface of this muscle. M: zygomaticus major muscle, N: facial nerve branch. British Journal of Plastic Surgery 2003 56, 110-113DOI: (10.1016/S0007-1226(03)00042-0)

Fig. 4 Recipient facial nerve branches are severed as far distally as possible. V: vessel tape, N: facial nerve branch. British Journal of Plastic Surgery 2003 56, 110-113DOI: (10.1016/S0007-1226(03)00042-0)

Fig. 5 The vessel tape is removed to bring the nerve stumps. British Journal of Plastic Surgery 2003 56, 110-113DOI: (10.1016/S0007-1226(03)00042-0)

Fig. 6 The stump of the recipient facial nerve branches are brought outside the stab incision. British Journal of Plastic Surgery 2003 56, 110-113DOI: (10.1016/S0007-1226(03)00042-0)

Fig. 7 Pre-auricular and cheek scars were imperceptible. British Journal of Plastic Surgery 2003 56, 110-113DOI: (10.1016/S0007-1226(03)00042-0)