Facial reanimation with gracilis muscle transfer neurotized to cross-facial nerve graft versus masseteric nerve: A comparative study using the FACIAL CLIMA Evaluating System
Hontanilla B, Marre D, Cabello A.
Department of Plastic and Reconstructive Surgery, Clinica Universidad de Navarra, Spain.
Long-standing unilateral facial paralysis is best addressed with microneurovascular muscle transplant. Neurotization of such muscle unit can be obtained from different sources, the most frequent being the contralateral facial nerve via cross-face nerve graft (CFNG) or the motor nerve to the masseter. This work presents a quantitative comparison of both procedures using the FACIAL CLIMA system.
Forty seven patients with complete unilateral facial paralysis underwent reanimation with free gracilis transplant neurotized to either a CFNG (group I, n=20) or to the ipsilateral masseteric nerve (group II, n=27). Commissural displacement (CD) and commissural contraction velocity (CCV) were measured using the FACIAL CLIMA system. Postoperative intragroup CD and CCV means of the reanimated versus the normal side were first compared using independent sample Student's t test. Following, mean percentage of recovery of both parameters were compared between the groups using independent sample Student's t test.
Significant differences of mean CD and CCV between the reanimated side and the normal side were observed in group I (p = 0.001 and 0.014, respectively) but not in group II. Intergroup comparisons showed that postoperatively, both CD and CCV were higher in group II, with significant differences for CD (p = 0.048). Mean percentage of recovery of both parameters was higher in group II, with significant differences for CD (p = 0.042).
Free gracilis muscle transfer neurotized by the masseteric nerve is a reliable technique for reanimation of long-standing facial paralysis. Compared to CFNG neurotization, this technique provides better symmetry and a higher degree of recovery.
CITA DEL ARTÍCULO Plast Reconstr Surg. 2013 Feb 14