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Microvascular free gracilis transfer improved oral commissure symmetry, smile outcome
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Improvements in oral commissure symmetry and smile excursion were evident after facial reanimation using microvascular free gracilis transfer in a recent study.
Researchers conducted a retrospective medical chart review of 148 patients who underwent microvascular free gracilis transfer for smile at the Massachusetts Eye and Ear Infirmary from March 2003 to March 2013. Smile excursion, smile angle with respect to the vertical midline and facial symmetry during repose and with smile were outcome measures. An automated tool for accessing facial landmarks was developed and used for measurements.
There were 154 microvascular free gracilis transfers performed for facial reanimation during the study; 14 (9%) were considered failures. One hundred twenty-seven procedures met inclusion criteria (124 patients; mean age, 35 years; 58% women). After gracilis free flap, improvements were noted in smile excursion, angle excursion and symmetry of oral commissure at repose and with smile (P<.05.
“In the experience at a single institution, smile excursion in the frontal plane reaches a mean of 8 mm following [gracilis free tissue transfer],” the researchers said. “Gracilis free tissue transfer is a reliable procedure for dynamic reanimation of the paralyzed oral commissure.
“Successful muscle transfers result in measureable improvements in smile excursion and oral commissure symmetry, and both muscle recoil and contractility parameters relate to final outcome. We were unable to discern a difference between failure rates based on nerve used, but such a difference may exist.”
Disclosure: The researchers report no relevant financial disclosures.
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