Powering the Gracilis for Facial Reanimation

Vila, Peter M.; Kallogjeri, Dorina; Yaeger, Lauren; John, J.

doi:10.1001/jamaoto.2020.0065

Cited by 22 publications

(12 citation statements)

References 51 publications

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“…While preliminary outcomes are promising, tremendous debate remains regarding the most optimal nerve for innervating the gracilis (Chuang et al, 2018; Vila et al, 2020). In our series, the facial nerve, masseteric nerve, hypoglossal, and spinal accessory nerve were all used to innervate the gracilis.…”

Section: Discussionmentioning

confidence: 99%

“…Otherwise, an end‐to‐side neurorrhaphy were performed. Further studies are needed to define the most optimal donor nerve (Chuang et al, 2018; Mohanty et al, 2019; Vila et al, 2020). Three of our patients underwent facial nerve grafting in combination with the functional gracilis transfer which likely affords patients the best possible potential outcome by combining the benefits of facial nerve grafting as well as a dynamic functional muscle transfer.…”

Section: Discussionmentioning

confidence: 99%

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The combined profunda artery perforator‐gracilis flap for immediate facial reanimation and resurfacing of the radical parotidectomy defect

et al. 2022

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Background A radical parotidectomy with facial nerve sacrifice results in facial nerve paralysis as well as a volume and often cutaneous defect. Prior experience with nerve grafting and static suspension has yielded suboptimal results. The present report aims to examine the feasibility and outcomes of a combined free gracilis and profunda artery perforator (PAP) flap from a single donor site can reconstruct these extensive defects and potentially restore dynamic facial reanimation even in the setting of adjuvant radiation. Patients and Methods A retrospective review of 10 patients (6 males and 4 females) was performed from 2016 to 2020 that underwent a combined PAP‐gracilis reconstruction of a radical parotidectomy defect. All patients (mean age: 71.3 years; range: 52–83 years) received adjuvant radiation. A chimeric PAP‐gracilis flap requiring a single microvascular anastomosis was performed in three patients while the remaining patients underwent a double free flap reconstruction. Results The gracilis flap was innervated using the facial nerve stump, spinal accessory and massecteric nerve in three patients each. One patient's gracilis was innervated using the hypoglossal nerve. Three patients also underwent nerve grafting of the facial nerve. One patient was taken back to the operating room for a hematoma in the recipient site and there were not flap losses of either the PAP or gracilis flap. Two patients had delayed wound healing of the donor site that healed with conservative management. Average follow‐up was 11.1 months (range: 8.1–19.5 months). Six patients were able to achieve dynamic animation while the others obtained a static reconstruction and did not have issues with drooling, eating, or speaking. Conclusions Immediate functional muscle transfer can potentially restore dynamic facial reanimation even following radiation. Combining reconstruction using a PAP‐gracilis flap addresses the soft tissue deficit and facial paralysis using a single donor site in a single operation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The combined profunda artery perforator‐gracilis flap for immediate facial reanimation and resurfacing of the radical parotidectomy defect

et al. 2022

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“…The free GFMT has a neglectable low donor site morbidity. 22 , 23 , 30 , 31 , 32 Similarly, harvest‐related morbidities are extremely rare after SAFF use and signs of scapular winging are seldom reported, 33 while the overwhelming majority of patients show no difference regarding upper extremity function compared to healthy controls. 16 , 34 , 35 , 36 , 37 Therefore, the SAFF is considered as favorable option regarding donor site morbidity compared to other flaps.…”

Section: Discussionmentioning

confidence: 99%

“…However, meta‐analyses failed to demonstrate statistically significant benefits. 31 , 32 , 39 According to current data, we would therefore recommend to primarily perform end‐to‐end anastomosis of the LTN with fascicles or branches of the ipsilateral facial nerve and secondly coadaptation with the ipsilateral MN (Figure 2A,B ). Whether patients may further benefit from additional intramuscular neurotization by the MN to achieve dual innervation seems likely but needs to be subject of subsequent studies.…”

Section: Discussionmentioning

confidence: 99%

Using the serratus anterior free flap for dynamic facial reanimation: Systematic review

Janik

Marijić

Faisal³

et al. 2022

Head & Neck

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It was the purpose of this study to evaluate the role of the serratus anterior free flap (SAFF) with its long thoracic nerve (LTN) as composite flap for dynamic facial reanimation. A total of 10 studies, published between 2004 and 2021, met inclusion criteria. Clinical data of 48 patients were used for the systematic review and analysis. One to three slips were used, mainly as one‐stage procedures (n = 39; 81.3%), to create different force vectors. Single or double innervated muscle transfers were utilized in 32 (66.7%) and 16 (33.3%) cases with additionally harvested skin paddles in 4 (8.3%) patients. The LTN was mostly anastomosed to the ipsilateral masseteric nerve (45.8%; n = 22) or to remaining facial nerve branches (37.5%; n = 18), while cross‐facial‐nerve‐grafting was rarely used (16.7%; n = 8). The SAFF as composite flap with different force vectors proved to be a good candidate for immediate dynamic facial reanimation after any midface defects.

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“…Therefore, the amount of benefit from medical therapy vs from PT could not be assessed in our systematic review. Therefore, we recommend that future studies use standardized reporting measures to better stratify and compare outcomes in facial nerve care and research …”

Section: Discussionmentioning

confidence: 99%

Physical Therapy for Iatrogenic Facial Paralysis

Wamkpah

Jeanpierre

Lieu

et al. 2020

JAMA Otolaryngol Head Neck Surg

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acial paralysis (FP) secondary to surgery has a reported incidence of 11% to 40%. 1 Rates of iatrogenic FP vary by surgery type: oral-maxillofacial surgery is the most common (40%), followed by head and neck surgery (25%), otologic surgery (17%), and cosmetic surgery (11%). 1 For patients, FP is associated with substantial functional, emotional, and financial consequences. [2][3][4] Given its detrimental impact, iatrogenic FP is an important complication for otolaryngologists, plastic surgeons, oral surgeons, and dermatologists to manage. Most iatrogenic FP is expected to be temporary 5 and is managed by watchful waiting.Treatment options to encourage facial function recovery are varied, including medical therapy (ie, corticosteroids) and physical therapy (PT). 5 Physical therapy is advantageous because it is noninvasive and encourages patients to actively participate in their recovery. 6 However, there is a paucity of literature on the effectiveness of PT. Although a 2011 Cochrane review by Teixeira et al 7 found no high-quality evidence supporting the benefit or harm of PT for idiopathic FP, studies of PT for iatrogenic FP are limited to a few randomized controlled trials (RCTs) 5,8 and observational studies. 9 Iatrogenic FP can occur despite meticulous surgical dissection and intraoperative confirmation of facial nerve continuity likely because of local manipulation. 1 Therefore, iatrogenic FP represents a pathogenesis unique from idiopathic FP, which is often stated to result from inflammation after viral infection. 7 The primary objective of this systematic review was to investigate whether noninvasive PT compared with no PT or other intervention improves facial nerve outcomes in adults with iatrogenic FP. Methods Study DesignThe Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) 10 guidelines were followed in this systematic IMPORTANCE Facial paralysis (FP) after surgery has substantial functional, emotional, and financial consequences. Most iatrogenic FP is managed by watchful waiting, with the expectation of facial function recovery. A potential treatment is physical therapy (PT).OBJECTIVE To investigate whether noninvasive PT compared with no PT or other intervention improves facial nerve outcomes in adults with iatrogenic FP.LP;&-2QEVIDENCE REVIEW Patients with noniatrogenic FP, facial reanimation surgery, and invasive adjunctive treatments (acupuncture or botulinum toxin injection) were excluded. A systematic review was conducted for records discussing iatrogenic FP and PT; a search for these records was performed using

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Powering the Gracilis for Facial Reanimation

Cited by 22 publications

References 51 publications

The combined profunda artery perforator‐gracilis flap for immediate facial reanimation and resurfacing of the radical parotidectomy defect

The combined profunda artery perforator‐gracilis flap for immediate facial reanimation and resurfacing of the radical parotidectomy defect

Using the serratus anterior free flap for dynamic facial reanimation: Systematic review

Physical Therapy for Iatrogenic Facial Paralysis

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