Secondary Dynamic Reconstruction of Perioral and Periorbital Deformities Using Bi-Paddled Latissimus Dorsi Muscle Transfer in Patient After Maxillectomy

Midfacial deformities after maxillectomy present complex challenges, requiring restoration of contour, oronasal separation, orbital support, and smile. Despite the advances in immediate reconstruction with free flaps, aesthetic and dynamic deficits often persist. These deficits mimic facial paralysis despite not representing true paralysis. The authors report a 43-year-old woman who underwent secondary dynamic reconstruction using a bi-paddled latissimus dorsi muscle transfer after total maxillectomy and reconstruction with a deep inferior epigastric flap. One muscle flap restored elevation of the oral commissure, whereas the other enabled "eye smiling". The thoracodorsal nerve was anastomosed to the buccal branch of the ipsilateral facial nerve responsible for oral commissure elevation. In addition, 2 tensor fascia lata grafts corrected eyelid drooping and contralateral nasal ala deviation. Muscle contraction appeared at 3 months, and spontaneous smiling with palpebral fissure narrowing was achieved by 21 months. To our knowledge, this is the first successful dual-region dynamic reanimation reported for post-maxillectomy deformity.