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

Abstract

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.

Anatomische Auffindbarkeit und Möglichkeiten des Transfers des Nervus massetericus zur Gesichtsreanimation

“…Gründe gelegentlicher Skepsis sind vergleichsweise mangelhafte Ergebnisse hinsichtlich Ruhetonus und -symmetrie sowie die vermeintlich geringere emotionale Kopplung [2,20]. Letzterem widersprechen allerdings rezente Arbeiten [1,3,11,21,22], welche die Ergebnisse hinsichtlich postoperativ spontanen Lächelns als durchaus vergleichbar einordnen. Als positiv prädiktiver Faktor für gute emotionale Kopplung wurde die präoperativ elektromyographisch gemessene Aktivierung des M. masseter bei spontanem Lächeln beschrieben [23].…”

Special Issue: Evidence-Based Diagnosis and Management of Facial Nerve Disorders

“….] 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" [10].…”