Use of the submental vessels for free gracilis muscle transfer for smile reanimation

Goyal, Neerav; Jowett, Nate; Dwojak, Sunshine M.; Cunane, M.; Zander, David; Hadlock, Tessa A.; Emerick, Kevin S.

doi:10.1002/hed.24478

Cited by 3 publications

(2 citation statements)

References 8 publications

(6 reference statements)

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“…Nevertheless, some sparse cases have been reported. Goyal et al discussed a case series of patients undergoing reintervention due to previously failed facial reanimations (Goyal et al, 2016). They successfully performed five facial reanimations with reinnervated gracilis muscle free flaps anastomosed to the ipsilateral submental vessels.…”

Section: Discussionmentioning

confidence: 99%

Inverted gracilis muscle free flap with intraoral vascular anastomoses for facial reanimation in vessel depleted neck: A case report

De Cicco,

Bottini,

Lizambri

et al. 2023

Microsurgery

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The reinnervated gracilis muscle free flap represents a workhorse of facial reanimation. This procedure is carried out secondarily to parotid resections, due to advanced tumors that spread to the surrounding structures. Finding recipient vessels might be problematic if other reconstructive procedures are needed to address the defects. This paper describes a procedure to inset a reinnervated gracilis muscle free flap in a vessel depleted patient, through intraoral anastomoses to avoid venous interposition grafts. A 52‐year‐old man developed an advanced adenocarcinoma of the deep parotid lobe and underwent radical surgical excision including the mandibular ramus, condyle, and facial soft tissues (defect size: 8 cm × 4 cm). A secondary double‐flap reconstruction restored the mandibular defect and inset a cross‐face nerve graft. A third intervention finalized the facial reanimation with a 10 cm reinnervated gracilis muscle free flap. The gracilis flap inset was inverted resulting in the proximal flap (pedicle side) lying on the buccal aspect. This allowed vessel joining from the contralateral side via intraoral anastomoses. No complications occurred within and after the intervention. However, the adenocarcinoma relapsed before reinnervation of the gracilis. The patient also had distant brain and lung metastases and received best supportive care. The inverted gracilis muscle free flap may represent an option for attaining facial reanimation in vessel‐depleted patients avoiding long interposition venous grafts.

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Section: Discussionmentioning

confidence: 99%

Inverted gracilis muscle free flap with intraoral vascular anastomoses for facial reanimation in vessel depleted neck: A case report

De Cicco,

Bottini,

Lizambri

et al. 2023

Microsurgery

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“…To avoid the need for vein grafting, the short vascular pedicle of the gracilis muscle (approximately 6 cm) necessitates donor vessels in close proximity to the inset. As the superficial temporal vessels, retromandibular vein, and internal maxillary artery are often ablated in such cases, the surgeon is reliant upon intact ipsilateral facial (see Figure ) or submental vessels . We commonly obtain preoperative CT angiography in patients with no palpable arterial pulse from the facial artery at the mandibular body, and in patients for whom the status of the facial vein is unknown after neck dissection.…”

Section: Methodsmentioning

confidence: 99%

Free gracilis muscle transfer for smile reanimation after treatment for advanced parotid malignancy

et al. 2017

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Reanimation of the Smile with Neuro-Vascular Anastomosed Gracilis Muscle: A Case Series

et al. 2022

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Background: The aim of our manuscript was to evaluate the time course of clinical and electromyographical (EMG) reinnervation after the reanimation of the smile using a gracilis muscle transplant which is reinnervated with the masseteric nerve. Methods: We present a case series of five patients with a longstanding peripheral facial palsy, who underwent a reanimation of the lower face using a gracilis muscle transplant with masseteric nerve reinnervation from June 2019 to October 2020. Trial-specific follow-up examinations were carried out every three months using clinical assessment and EMG, up to 12 months after the surgery. The grading was carried out using the House–Brackmann scale (HB), the Stennert Index, and a self-designed Likert-like scale for graft reinnervation and smile excursion. Results: The surgery was feasible in all of the patients. The reanimation was performed under general anesthesia in an inpatient setting. Postoperative complications which resulted in prolonged hospitalization occurred in two of the five patients. All of the patients showed a preoperative flaccid facial palsy. The first single reinnervation potentials were detected 3.1 ± 0.1 months after surgery. After 5.6 (±1.4) months, in three (3/5) patients, clear reinnervation patterns were present. Clinically, the patients obtained symmetry of the face at rest after 5.6 (±1.4) months, and could spontaneously smile without the co-activation of the jaw after an average time of 10.8 (±1.8) months. All of the patients were able to express a spontaneous emotion-stimulated smile after one year. Conclusion: Micro-neurovascular gracilis muscle transfer reinnervated with a masseteric nerve is a sufficient and reliable rehabilitation technique for the lower face, and is performed as a single-stage surgery. The nerve supply via the masseteric nerve allows the very rapid and strong reinnervation of the graft, and results in a spontaneous smile within 10 months.

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Use of the submental vessels for free gracilis muscle transfer for smile reanimation

Abstract: The submental vessels are suitable for microvascular anastomosis for free flaps having short pedicles, such as the free gracilis muscle flap, in the vessel-depleted hemiface. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-E2503, 2016.

Cited by 3 publications

References 8 publications

Inverted gracilis muscle free flap with intraoral vascular anastomoses for facial reanimation in vessel depleted neck: A case report

Inverted gracilis muscle free flap with intraoral vascular anastomoses for facial reanimation in vessel depleted neck: A case report

Free gracilis muscle transfer for smile reanimation after treatment for advanced parotid malignancy

Reanimation of the Smile with Neuro-Vascular Anastomosed Gracilis Muscle: A Case Series

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