Facial Reanimation in Moebius Syndrome Using Bilateral Free Gracilis Transfer: 1-Stage versus 2-Stage Procedures

Area of Science:

• Plastic Surgery
• Craniofacial Surgery
• Pediatric Surgery

Background:

• Complete Moebius Syndrome (CMS) is a rare congenital disorder affecting cranial nerves VII and VI.
• It results in bilateral facial paralysis and limited eye movement (ocular abduction).
• Bilateral free gracilis muscle transfer (FGMT) is the established surgical treatment, traditionally performed in two stages.

Purpose of the Study:

• To compare the surgical outcomes and long-term results of a novel one-stage bilateral FGMT with the traditional two-stage approach for CMS.
• To evaluate the efficacy, safety, and cost-effectiveness of the one-stage versus two-stage FGMT in CMS patients.

Main Methods:

• A retrospective cohort study included 18 CMS patients who underwent either one-stage or two-stage bilateral FGMT.
• Data collected included sociodemographic factors, perioperative/postoperative parameters, costs, patient satisfaction, and long-term aesthetic and functional outcomes.
• Follow-up averaged 8.1 years, with statistical analysis using chi-square and Mann-Whitney U tests (p < 0.05 significance).

Main Results:

• No significant differences in postoperative complications like flap loss, hematoma, or infections were found between the one-stage and two-stage groups.
• The one-stage procedure resulted in significantly shorter surgeries (p=0.050), reduced hospital stays (p=0.001), and lower overall costs (p=0.001).
• Long-term aesthetic and functional outcomes were comparable between both surgical approaches (p > 0.05).

Conclusions:

• One-stage bilateral FGMT is a safe and effective alternative to the two-stage procedure for CMS.
• The one-stage approach offers significant advantages in terms of cost-effectiveness, surgical duration, and hospital stay.
• Both methods yield similar satisfactory long-term aesthetic and functional results for patients with Complete Moebius Syndrome.