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Updated: Sep 13, 2025
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Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer
Published on: March 1, 2015
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Evaluating Dynamic Smile Outcomes of Free Gracilis Muscle Transfer in Pediatric Facial Palsy Using Image-Based
Melanie Bakovic1,2, Asli Pekcan1,3, Raina K Patel1,4
1Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California, United States.
Journal of Reconstructive Microsurgery
|July 30, 2025
Summary
Free gracilis muscle transfer (FGMT) improves smile movement in children with facial palsy, but achieving full facial symmetry remains a challenge. This study used image analysis to assess FGMT outcomes, finding improvements in some areas but not others.
Area of Science:
- Plastic Surgery
- Pediatric Surgery
- Reconstructive Surgery
Background:
- Facial nerve palsy in children causes significant functional impairment and asymmetry.
- Free gracilis muscle transfer (FGMT) is a key technique for smile reanimation.
- Current evaluations often focus narrowly on commissure excursion.
Purpose of the Study:
- To evaluate the effectiveness of FGMT in restoring dynamic smiles in pediatric patients with facial palsy.
- To assess multidimensional smile reanimation using image analysis.
- To identify specific areas of improvement and limitations of FGMT in this population.
Main Methods:
- Retrospective review of pediatric patients undergoing FGMT for facial palsy (2007-2020).
- Pre- and postoperative chart review and advanced image analysis using machine learning software.
- Measurement of anthropometric outcomes including commissure excursion, angle, dental show, and smile symmetry.
Main Results:
- 84% of patients showed active gracilis contraction post-surgery.
- Significant improvements were noted in commissure excursion (9.7 mm increase at 1 year), commissure height, upper lip height, and smile angle symmetry.
- No significant improvements were observed in dental show, commissure angle, or lower lip height symmetry; only 16% achieved clinically symmetric smiles.
Conclusions:
- FGMT is effective in improving commissure excursion for pediatric facial palsy patients.
- Achieving comprehensive, multidimensional smile reanimation remains a challenge with current FGMT techniques.
- Further advancements, such as multi-vector free tissue transfer, may enhance FGMT outcomes in pediatric smile restoration.
