Revascularized muscle transfer for facial reanimation after long-standing facial paralysis

The aim of the present study was to evaluate the results of a group of patients who had received free vascularized muscle transfer to the face for the treatment of long-standing facial paralysis. In 15 patients, neurovascular transfer of 16 segments of the gracilis muscle to the cheek was performed for reanimation of oral commissure movement. Voluntary muscle activation was evaluated by electromyography (EMG) and clinical function was assessed both metrically from frontal photographs and by a rating system with 6 categories. Patient satisfaction was explored through a self-administered questionnaire of general health (SF-36 health survey). The average follow-up period was 49.3 months. All patients showed voluntary activation of the grafted muscles in the EMG. Symmetry of the static and dynamic position of the oral commissure at rest and under function was considerably improved. In general, however, there was a tendency for undercorrection particularly in a vertical direction. Under function, the excursion of the oral commissure on the grafted side reached 63.7% and 65.5% of the nonparetic side in vertical and horizontal directions, respectively. Subjective rating of patient well-being showed that the scores were higher than or comparable to those of healthy adults in six of eight areas of evaluation.