Donor nerve selection in free gracilis muscle transfer for facial reanimation. A systematic review and meta-analysis of clinical outcomes

Bayezid, Kadir C.; Joukal, Marek; Karabulut, Erdem; Máček, Ján; Moravcová, Ludmila; Streit, Libor

doi:10.1016/j.bjps.2023.04.014

Cited by 6 publications

(3 citation statements)

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“…However, it was stated that the use of the motor nerve to the masseter as a nerve donor in free gracilis muscle transfer is ideal for bilateral facial paralysis and in elderly patients as it is less invasive. 33 An important consideration found by the authors of this study is that, although the crossface nerve graft was the most commonly utilized nerve donor, the outcomes were not statistically significant in relation to facial symmetry upon resting and smiling. 27 Moreover, Takushima et al 34 research evaluated the outcomes of onestage LD free muscle transfer in unilateral longstanding facial paralysis patients.…”

Section: Discussionmentioning

confidence: 75%

“…Positive outcomes were noted in Zuo et al's 39 study as free functional muscle flap transfer achieved improved muscle contraction, lip symmetry, and oral commissure excursion. Conversely to Bayezid et al, 33 Chuang et al 36 and Kalra et al, 37 Roy et al 40 concluded that masseter nerve innervation produced more positive results in relation to smile excursion in comparison to cross-face nerve graft innervation.…”

Section: Discussionmentioning

confidence: 95%

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Outcomes of Free Flap Transfer in Facial Reanimation: A Review

Shamil,

Tan,

Grobbelaar

2024

Facial Plast Surg

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Free functional muscle transfer is is an option for reanimating the face in chronic facial nerve paralysis. The optimal outcome in these patients is the ability to restore a spontaneous smile in response to emotion. We discuss the role of free functional muscle transfer in facial paralysis treatment, the choices of nerve used in reconstruction surgery, and the application of different types of muscle flaps in facial reanimation. In this paper, we review the relevant and up-to-date academic literature regarding the outcomes of free functional muscle flap transfer in facial paralysis patients.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 95%

Outcomes of Free Flap Transfer in Facial Reanimation: A Review

Shamil,

Tan,

Grobbelaar

2024

Facial Plast Surg

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“…Executing this method demands detailed dissection of the masseteric nerve while preserving its proximal branches to prevent masseter muscle paralysis or deterioration [ 10 - 14 ]. When compared to CFNG, masseteric nerve myoplasty shows enhanced results in facial symmetry, recovery time, and overall success in single-stage procedures [ 15 - 17 ].…”

Section: Introductionmentioning

confidence: 99%

Dynamic Surgical Restoration of Mid and Lower Facial Paralysis: A Single-Greek-Centre Experience

Neamonitou,

Kotrotsiou,

Stavrianos

2024

Cureus

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Background Facial palsy detrimentally impacts an individual’s quality of life due to its effects on function and appearance. There are several reconstructive surgical techniques available that aim to restore facial symmetry. Techniques such as direct neurorrhaphy, nerve grafts, dual reanimation, and reinnervation have the potential to enable varying motor functions, including the re-establishment of a dynamic smile. This study aimed to assess the outcomes of facial palsy reconstructive surgeries undertaken at a tertiary care centre for facial nerve reconstruction in Athens. Methods This study consisted of a comprehensive case series showcasing the outcomes of facial palsy reconstructive surgeries on 29 patients at our Tertiary General Oncological Anti-Cancer Hospital of Athens ’Agios Savvas’. The surgical procedures from October 2004 to December 2023 included reinnervation, nerve grafting, free muscle transfer, and myoplasties following our recommended algorithm. We categorized the patients into two groups: Group A and Group B based on the timing of the reconstruction: delayed or immediate. The House-Brackmann grading scale evaluated the degree and improvement of facial paralysis. Results In Group A, two of the seven patients exhibited activation of the mimetic musculature immediately postsurgery, while the remaining five experienced enhanced facial nerve function in the subsequent months. Adverse outcomes were temporalis dysfunction in one case and tongue atrophy in another. Conversely, in Group B, 21 of 22 patients demonstrated facial activation immediately postsurgery. Only one patient from this group did not show any facial nerve function postoperatively. Two of the 22 patients in Group B encountered complications: one with trismus and another with temporalis dysfunction. All patients were observed for a minimum of 12 months postsurgery. Conclusion With the exception of one patient, all participants showed improved postoperative results, which were satisfactory when weighed against the observed morbidity rate. While our case analysis did not reveal any clear indication of one particular technique being superior, the selection of methods should be based on several factors, and this algorithm could serve as a useful aid in that regard. A comprehensive and standardized clinical assessment of facial palsy, both before and after surgery, is crucial to establish a consensus and plan individualized therapy.

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