Free Vastus Lateralis Functional Muscle Transfer: An Approach to Facial Reanimation and Reconstruction in Radical Parotidectomy.

Background: Our report focuses on a new method for reanimating the facial nerve and reconstructing soft tissue after radical parotidectomy due to malignant parotid tumor infiltration. We found that using the free vastus lateralis functional muscle transfer (FVL-FMT) can be effective. Methods: FVL-FMT is an immediate single-stage reconstruction technique. It uses 2 branches of the vastus lateralis motor nerve-the descending (type 1) and oblique (type 2) branches-to supply the transferred free functional muscle. The descending branch also acts as a vascularized nerve graft that reconnects the facial nerve and its branches. It was used in a review of patients with stage IVA parotid cancer who underwent radical parotidectomy, with facial function assessed using modified House-Brackmann and Yanagihara facial nerve grading scales. Results: Seven patients underwent facial nerve reconstruction, 6 with type 1 and 1 with type 2 FVL-FMT. Three patients regained normal ocular function, whereas 4 achieved moderate dysfunction for the lower midface. The modified House-Brackmann scores were III (n = 3, 42.9%), IV (n = 2, 28.6%), and V (n = 2, 28.6%), whereas the Yanagihara system scores ranged from 4 to 30. All patients had minimal synkinesis, and 6 (86%) achieved acceptable symmetrical resting tone. All flaps survived, and ocular complications and feeding problems were absent. Conclusions: Immediate facial nerve reconstruction can improve the quality of life for patients with facial palsy after surgery. The vastus lateralis functional muscle transfer is a reliable method that restores function and appearance in facial nerve defects.