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Plastic and Reconstructive Surgery

Graduate School of Medicine, The University of Tokyo

Greeting from Professor


Mutsumi Okazaki, M.D., Ph.D.
Professor and Chair, Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo.

Profile

1990 Graduated from The University of Tokyo, School of Medicine.
2000 Chief, Department of Plastic Surgery, Asahi General Hospital.
2002 Assistant professor, Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital.
2006 Associate professor, Department of Plastic Surgery, Kyorin University.
2009 Professor and Chair, Department of Plastic and Reconstructive Surgery, Graduate School of Science, Tokyo Medical and Dental University.
2017 Professor and Chair, Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo.

International Associate Editor, Plastic and Reconstructive Surgery ®
International Associate Editor, PRS Global Open (2015-2020).

Field of expertise

  • Reconstruction of facial deformity and dysfunction
  • Reanimation for facial paralysis
  • Microsurgery

Reanimation for Facial Paralysis

At Plastic and Reconstructive Surgery in The University of Tokyo Hospital, we perform surgical operations that are highly satisfying for patients using our ideas and ingenious and dexterous techniques, and had published the achievements obtained for the benefit of the world. Here we present our surgical treatments of facial nerve paralysis

1. Reconstructive operations around the eyes using eyeblink evaluation as an indicator A patient with facial nerve paralysis suffers in two ways: eyelid opening difficulty occurs due to upper eyelid ptosis caused by frontalis muscle paralysis, and eyelid closure disorder also results from orbicularis oculi muscle paralysis. Regarding eyelid closure disorder, until now, the ability to intentionally close the eyelid has been used as an indicator.

However, symptoms that trouble patients are related to eyeblink, such as corneal inflammation and dryness or pain in the eyes. Therefore, in 2016, our division introduced an eyeblink evaluation using a high-speed camera. An eyeblink test is conducted on patients with facial nerve paralysis, with several tens of thousands of frames analyzed with each test. Based on the analysis results, a reconstructive procedure for the area around the eyes that best suits each patient is determined, as well as the appropriate amount of correction (Figure 1).

2. Reconstruction of laughing and eyelid closing functions using multi-split vascularized nerve and muscle Patients with facial nerve paralysis tend to avoid laughing as much as possible because facial asymmetry becomes conspicuous when laughing due to the mouth being pulled to the opposite side, caused by impaired muscle movement involved in the process. From the viewpoint of QOL, restoring the ability of patients to laugh by reconstructing movement affected by paralysis is a highly significant achievement. Nerve and muscle transplantation has been conducted using microscopic microvascular anastomosis. As the power source for muscle power movement, either 1) a facial nerve on the opposite side or 2) the masseteric nerve on the same side has been used. While 1) has the benefit of enabling unintentional spontaneous laughing, movement was occasionally weak. Similarly, while 2) enabled intentional and strong movement, unintentional spontaneous laughing is difficult, and therefore patients had to artificially make laughing motions through initiating biting movement. The technique required for 2) is easier, making this procedure still the more popular choice in many countries, particularly Europe and the U.S. The procedure for 1), which is more difficult, is performed at five to ten facilities across Japan. Both 1) and 2) have their respective strengths and weaknesses, with the selection for one or the other largely depending on the skill level of the surgeon. Our division has devised and published a hybrid method that splits into two a single muscle supplied by a pair of artery and vein, and sutures the nerve of the respective muscle to the facial nerve of the healthy side and to the masseter nerve of the affected side1) 2) (Figure 2). This method combines the strengths of both procedures above, enabling the patient both to laugh spontaneously as well as artificially, with a level of surgical intervention that is mostly equivalent to 1) or 2). We have also devised a procedure that further advances the technique above by splitting the muscle into three, and transplanting them while suturing the respective nerves to different nerves, thereby achieving intentional eyelid closing function in addition to the above (Figure 3).

3. More complex reconstruction of facial features and functional disorders Major deformation of the face may result in patients with bone or soft tissue defects in addition to facial nerve paralysis, due to tumor resection or traumatic injury. For such patients, we perform surgery to transplant vascularized bones and adipose tissue at the same time as muscle (Figure 4). Simultaneous implementation of such a complex procedure reduces the required number of surgical operation sessions, thereby relieving burden to the patient, and also supporting faster rehabilitation.

Figure4. Free dual LD muscle transfer combined with dual adipose flaps (reference 3).

4. Treatment of viral facial nerve palsy sequelae Viruses make up a large share with regard to the causes of facial nerve palsy. Owing to multidisciplinary drug treatment in Otorhinolaryngology, severe sequelae have become rarer in recent years. However, it is easy to imagine the extreme stress to patients resulting from sequelae to the face, as it is one of the most conspicuous parts of the body. Typical sequelae include: weak facial movement even though the face is pulled relatively strongly while the affected side is at rest (contracture type); synkinetic movement that is different from that intended (the corner of the mouth is pulled sideways, even though the patient wants to close his/her eyelid; the eye closes when the patient moves his/her mouth: synkinesis); and a drooping eyebrow resulting in a drooping eyelid that hinders the patient’s vision despite the patient being mostly recovered. We provide tailor-made treatments for each patient while listening to their complaints. At The University of Tokyo Hospital, a cooperative structure has been established with the Otorhinolaryngology Department. Once otorhinolaryngologic treatment has been completed, the patient is transferred to Reconstructive Surgery. We support enhanced QOL of patients by seamlessly taking over the treatment process, even if sequelae endure. If you are seeking medical advice concerning facial deformation or movement disorder (facial nerve palsy): See the details regarding symptoms and treatment by visiting https://www.h.u-tokyo.ac.jp/english/centers-services/clinical-divisions/plastic/index.html. Requests for consultation and inquiries concerning hospital visits from patients with facial nerve palsy are accepted at the e-mail address below:
utokyoprs.counsel@gmail.com

★ Free Neuromuscular Transfer for Facial Reanimation
1) Okazaki M, Tanaka K, Uemura N, Usami S, Homma T, Okubo A, Hamanaga M, Mori H. One-Stage Dual Latissimus Dorsi Muscle Flap Transfer with a Pair of Vascular Anastomoses and Double Nerve Suturing for Long-Standing Facial Paralysis. J Plast Reconstr Aesthet Surg. 2015; 68: e113-9.
2) Homma T, Okazaki M, Tanaka K, Uemura N. Simultaneous Surgical Treatment for Smile Dysfunction and Lagophthalmos Involving a Dual Latissimus Dorsi Flap. Plast Reconstr Surg Glob Open. 25; 5: e1370, 2017.
3) Ogawa K, Okazaki M, Tanaka K, Uemura N, Homma T. One-Stage Simultaneous Augmentation of 2 Regions of 3 Facial Reanimations After Mid Skull Base Surgery by Using a Neurovascular Latissimus Dorsi Chimeric Flap. J Craniofac Surg. 2021; 730-733.
4) Ogawa K, Okazaki M, Tanaka K, Uemura N, Homma T. Chimeric Latissimus Dorsi Flap in One-Stage Reconstruction of Depressor Muscle Dysfunction and Depression Deformity in the Perimandibular Area. J Craniofac Surg. 2021; 32(7): 2512-2515.

★ Blink and Movement Analysis
5) Hidaka T, Kurita M, Ogawa K, Tomioka Y, Okazaki M. Application of Artificial Intelligence for Real-Time Facial Asymmetry Analysis. Plast Reconstr Surg. 2020 Aug;146(2):243e-245e.
6) Hidaka T, Ogawa K, Tomioka Y, Yoshii K, Tomio J, Okazaki M.
Change in Eyelid Closure in Spontaneous Blinking After Static Eyelid Reconstruction Surgery for Patients With Facial Paralysis. Ann Plast Surg. 2021 Sep. Online ahead of print.
7) Ogawa K, Okazaki M, Mori H, Hidaka T, Tomioka Y, Tanaka K, Uemura N, Akiyama M. Comparative Blink Analysis in Patients With Established Facial Paralysis Using High-Speed Video Analysis. J Craniofac Surg. 2021 Nov 5. Online ahead of print.

★ Others
8) Hidaka T, Miyamoto S, Ogawa K, Tomioka Y, Okazaki M. Factors Associated With Late Admission to Facial Plastic Surgery Among Patients With Long-Standing Facial Paralysis. Ann Plast Surg. 2021. Online ahead of print

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