Korean Lepr Bull.  2020 Dec;53(1):15-21. 10.33161/klb.2020.53.1.15.

An Easy Method of Masseter muscle sling for lower lip paralysis in senile Hansen Patients

• Ahn SY
• Kim JP
• Park HJ

• KMID: 2516686
• DOI: http://doi.org/10.33161/klb.2020.53.1.15

Abstract

Background
One of the Sequelae of facial nerve paralysis in leprosy patients is severe eye and lip deformity. Eye deformities are most common, followed by unilateral lip deviation. When there is bilateral failal nerve paralysis, the lower lip drooping may occur. The lower lip drooping makes mouth closure incomplete, so the fluid or saliva may flow out when eating. And the teeth may be exposed or even the gum may be visible, which causes serious cosmetic and functional impairments.
Objective
It is to evaluate the masseter muscle sling (MMS) method in the treatment of the recurrent lower lip drooping in patients with Hansen's disease.
Methods
In the case of masseter muscle sling, there is a traditional method of detaching, separating and raising anterior masseter muscle in half from the mandibular jaw line and fixing it to the lip muscle. However, the authors observed a 3cm gap between the anterior border of masseter muscle and the lateral edge of orbicularis oris muscle. Under the local anesthesia the nasolabial line was incised and 3-4 places were pulled up between both musle edges and plicated with a 2/0 PDS??threads the gap-space.
Results
During 5 years (2016-2020), there were 17 recurrent lower lip palsy patients. The mean age was 71.3 years and the ratio of male and female was 9:8. Of 17 patents, 12 received temporal muscle transfer (TMT) attached with tensor fascia lata (TFL), 2 received temporal muscle transfer attached with Alloderm, and 3 received masseter muscle sling alone. The postoperative results of corrective masseter muscle sling were satisfactory in all 17 patients and there were no serious complication and recurrence during follow-up.
Conclusion
Masseter muscle sling is effective method in correction of recurrent lower lip drooping in patient with leprosy who treated previously with temporal muscle transfer attached with tensor fascia lata or temporal muscle transfer attached with Alloderm. In addition, masseter muscle sling may be considered as the first-line treatment in the lower lip paralysis.

Keyword

Facial nerve paralysis; Lower lip drooping; Masseter muscle sling