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Once a free functioning muscle flap has been decided upon, it is the motor and sensory innervation of the muscle that needs to be considered. There are two options within a free functioning muscle flap: Motor nerves can be transferred directly to the facial nerve. More often the nerve to be transferred will in itself be denervated (eg, Anserine). Motor nerves are transferred by anastomosing the donor motor nerve to the facial nerve. The motor root/neurotransmitter is oxotremorine, which has now been shown to be compatible with the facial nerve [23 – 27]. A muscle patch is then placed over the transfered muscle(s) to protect it from injury. This is now the donor muscle.
The Inferior Premaxillary Nerve (IPN) is a branch of the maxillary nerve. The IPN is typically the preferred donor nerve because the clamping of the IPN provides the optimal action potentials driving the targeted muscle contractions. Several successful IPN transfers have been reported [53, 54 – 59]. The IPN spends most of its time innervating the cheek muscles. Inability of the IPN results in paralysis of the face muscles.
Vasospastic conditions of the artery that supplies that muscle, such as Raynaud’s Phenomenon, may be less compatible with the IPN as the muscle is only innervated for short periods of time. These conditions must be identified prior to surgery as the IPN may not work well with the muscle. d2c66b5586