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Related Experiment Video

Updated: Jan 4, 2026

Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer
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Spontaneity Assessment in Dually Innervated Gracilis Smile Reanimation Surgery.

Joseph R Dusseldorp1,2, Martinus M van Veen1,3, Diego L Guarin1

  • 1Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston.

JAMA Facial Plastic Surgery
|November 1, 2019
PubMed
Summary

Cross-face nerve grafts may offer better smile spontaneity in facial reanimation than dual-innervated gracilis transfers. Objective assessment is crucial, as clinician ratings of spontaneity may not align with objective measures.

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Area of Science:

  • Plastic Surgery
  • Facial Nerve Surgery
  • Microsurgery

Background:

  • Facial reanimation surgery aims to restore smile function after paralysis.
  • Combining nerve sources like nerve-to-masseter and cross-face nerve grafts is explored to optimize outcomes.
  • Objective assessment tools are needed to compare different innervation strategies.

Purpose of the Study:

  • To evaluate a novel video time-stamping method for assessing smile reanimation outcomes.
  • To compare smile spontaneity in dually innervated gracilis free muscle transfers versus single-source innervated transfers.

Main Methods:

  • Retrospective cohort study of 25 patients undergoing gracilis free muscle transfers for unilateral facial palsy (2007-2017).
  • Comparison of dually innervated transfers with single-source (nerve-to-masseter or cross-face nerve graft) innervated transfers.
  • Objective assessment of spontaneous smiling using blinded, time-stamped video recordings.

Main Results:

  • Dually innervated gracilis transfers showed 33% spontaneous smile synchrony, compared to 20% for nerve-to-masseter and 75% for cross-face nerve graft.
  • Clinician assessment of spontaneity in dually innervated cases was often absent (40%) or trace (33%).
  • No significant association was found between clinician-reported spontaneity and objective video-based synchronicity measurements.

Conclusions:

  • Cross-face nerve graft-innervated gracilis transfers may yield superior smile spontaneity compared to dual-innervated or masseteric nerve-driven transfers.
  • Objective quantification of smile spontaneity is challenging and may differ from subjective clinical assessments.
  • Standardized assessment techniques are essential for reliable evaluation of facial reanimation outcomes.