Comparison of symmetry after smile reconstruction for flaccid facial paralysis with combined fascia lata grafts and functional gracilis transfer for static suspension or gracilis transfer alone

Kiefer, Jurij; Braig, David; Thiele, Jan; Bannasch, Holger; Stark, G. Björn; Eisenhardt, Steffen U.

doi:10.1002/micr.30324

Cited by 15 publications

(8 citation statements)

References 14 publications

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“…A profoundly disabling disorder, facial paralysis causes functional and psychological problems that have a significant impact on patients’ quality of life. The “gold standard” for smile rebuilding in patients with complete facial paralysis is free functional muscle transfers 13 . In particular, the gracilis muscle is the most popular free muscle flap, 14 and the selection of donor nerves is the key factor for this method.…”

Section: Discussionmentioning

confidence: 99%

“…The "gold standard" for smile rebuilding in patients with complete facial paralysis is free functional muscle transfers. 13 In particular, the gracilis muscle is the most popular free muscle flap, 14 and the selection of donor nerves is the key factor for this method. The most used donor nerves are the CFNG and masseteric nerve, which have their own characteristics and merits.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Outcomes of Facial Reanimation Between the Use of Cross-facial Nerve Graft and the Masseteric Nerve as the Donor Nerve for Reinnervation of Gracilis Muscle Flap Transfer

Liang,

Yang,

et al. 2023

Journal of Craniofacial Surgery

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Background: In patients with facial paralysis, the free functional gracilis muscle transfer is preferred for facial reanimation. The choice of an adequate motor nerve to innervate the transplanted gracilis muscle is one of the procedure’s key components. We present a comparative study between cross-facial nerve graft (CFNG) and masseteric nerve as donor nerves for reinnervated gracilis flap transfer in patients with complete facial paralysis. Materlals and Methods: Retrospective analysis was performed on all patients with complete facial paralysis who had a free functional gracilis muscle transfer for facial reanimation between January 2014 and December 2021. Only those who received gracilis transfer reinnervated by either CFNG or masseteric nerve were included in this study. The smile excursion and lip angle were measured for evaluating the outcomes postoperatively. Results: The inclusion criteria were met by a total of 21 free functional gracilis muscle transfers, of which 11 were innervated by CFNG and 10 by the masseteric nerve. Both surgical procedures resulted in a highly considerable smile excursion of the reanimated side and postoperative improvement of static or dynamic lip angle. Masseteric nerve coaptation led to greater smile excursion and more significant improvement of dynamic lip angle than CFNG. Conclusions: For patients who have complete facial paralysis, face reanimation can be successfully accomplished by free gracilis transfer reinnervated by the CFNG or the masseteric nerve. In particular, the masseteric nerve is a reliable choice for dynamic smile reanimation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of Outcomes of Facial Reanimation Between the Use of Cross-facial Nerve Graft and the Masseteric Nerve as the Donor Nerve for Reinnervation of Gracilis Muscle Flap Transfer

Liang,

Yang,

et al. 2023

Journal of Craniofacial Surgery

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“…Static slings are useful ancillary procedures in complex treatment for facial nerve disorders when combined with reinnervation surgery or in patients unsuitable for a more complex dynamic reconstruction 4,6 . Static facial rebalancing enhances self-image, self-esteem, and peer acceptance and accomplishes a subjective improvement in function and lip competence (pursing, puckering, fluid retention, and speech articulation) 9 …”

Section: Discussionmentioning

confidence: 99%

“…Static slings are useful ancillary procedures in complex treatment for facial nerve disorders when combined with reinnervation surgery or in patients unsuitable for a more complex dynamic reconstruction. 4,6 Static facial rebalancing enhances self-image, self-esteem, and peer acceptance FIGURE 6. Demonstration of Emotrics measurements in 32-year-old woman who experienced facial weakness after revision surgery for a complex pleomorphic adenoma.…”

Section: Sling Indications and Materialsmentioning

confidence: 99%

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A Comparative Study of Autologous and Acellular Dermal Matrix Static Cheek Slings in Corrective Surgery for Facial Palsy

2021

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Background Facial palsy causes devastating disability due to loss of facial function as well as social and psychological impairment. Cheek slings are a secondary technique that provide static support to the midface. This study aimed to describe our technique and compare a traditional sling material (tensor fascia lata) with a porcine-derived acellular dermal matrix alternative (Strattice). Methods A 5-year case-control retrospective review of consecutive static cheek slings in a tertiary cancer and facial palsy center was performed. Demographic data, risk factors, and complications were collected and compared. Improvement in static smile position was assessed by Emotrics (Massachusetts Eye and Ear Infirmary, Boston, MA) at 3 months. Long-term sling failure was assessed by need for reoperation. Results The study group comprised 41 patients on which 33 autogenous fascia lata slings and 12 Strattice slings were performed. Medium-term improvement in static smile position was similar between the 2 groups (judged by the Emotrics software), as was complication rate (P = 0.496). Need for revision due to stretching was higher in the Strattice group but did not achieve significance (P = 0.087). Mean follow-up was 38.02 ± 19.17 months. Twelve of 41 patients were deceased at study conclusion. Conclusions Fascia lata and Strattice slings provide satisfactory results in restoring symmetry at rest and functional oral competence. Our results suggest that Strattice is a safe sling material with an acceptable risk profile and comparable medium-term maintenance of tensile strength to fascia lata, and should be considered where life expectancy, donor site morbidity, and procedure length are important considerations.

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Principles of Smile Reanimation

Tzou

Rodríguez-Lorenzo

2021

Facial Palsy

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Comparison of symmetry after smile reconstruction for flaccid facial paralysis with combined fascia lata grafts and functional gracilis transfer for static suspension or gracilis transfer alone

Abstract: The combined procedure for dynamic facial reanimation allows for immediate correction of the oral asymmetry and improves overall outcome in patients with advanced soft tissue ptosis and oral asymmetry at rest.

Cited by 15 publications

References 14 publications

Comparison of Outcomes of Facial Reanimation Between the Use of Cross-facial Nerve Graft and the Masseteric Nerve as the Donor Nerve for Reinnervation of Gracilis Muscle Flap Transfer

Comparison of Outcomes of Facial Reanimation Between the Use of Cross-facial Nerve Graft and the Masseteric Nerve as the Donor Nerve for Reinnervation of Gracilis Muscle Flap Transfer

A Comparative Study of Autologous and Acellular Dermal Matrix Static Cheek Slings in Corrective Surgery for Facial Palsy

Principles of Smile Reanimation

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