Reanimation of the Lower Lip with the Anterior Belly of Digastric Transfer: A Systematic Review

Background: Dynamic reanimation of the lower lip is a challenging issue for patients, with depressor asymmetry commonly addressed with chemodenervation, selective neurectomy, or myectomy. Objective: To determine whether the anterior belly of digastric transfer is an effective method of lower-lip reanimation for patients with either isolated marginal mandibular branch weakness or inadequate depressor function after hemifacial reanimation, as measured by patient satisfaction and objective symmetry evaluation. Method: Systematic review of the literature was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Abstracts and full texts were reviewed. A Risk of Bias assessment was performed. Results: Nine studies with 164 patients were included. Anterior belly of digastric transfer was successfully performed in 162 patients. Most patients (52%) underwent one-staged reanimation innervated by the native nerve to the mylohyoid. A two-staged approach after placement of a cross face nerve graft was performed in 46%. Patient satisfaction was excellent (90.6%), with minimal complications including revision (4/162), infection (4/162), and lipofilling (8/162). Conclusion: In patients seeking a permanent outcome, use of an anterior belly of digastric transfer in either a one-stage or two-stage approach appears to be a safe and effective method to restore symmetry and dynamic function.