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Updated: Jan 9, 2026
Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer
Published on: March 1, 2015
A Possible Expanded Timeline for Salvage Facial Reanimation Surgery: A Case Report
Víctor A de Cos1, Rishi N Modi2, Sandhya Kalavacherla3
1Department of Otolaryngology-Head and Neck Surgery, University of Washington Medicine, Seattle, Washington, USA, vdecos@uw.edu.
Introduction:
Successful salvage facial reanimation procedures involving transfer of nerve to masseter (NTM) to an existing gracilis free muscle transfer (GFMT) have been reported when performed within 6 months.
Methods:
Medical records were reviewed for patients who had undergone a salvage or secondary facial reanimation surgery after an initial suboptimal GFMT by cross-face nerve graft (CFNG).
Case Presentations:
Between 2019 and 2024, three patients underwent salvage or secondary facial reanimation surgery after an initial procedure failed to produce movement by 11, 17, and 14 months respectively. Intraoperatively, the existing gracilis of patients 1 and 3 stimulated at 2 mA, and so a salvage procedure involving NTM transfer to the obturator nerve of the existing GFMT was performed. Successful smile was noted at 5 months for patient 1 and no facial movement after 12 months for patient 3. For patient 2, a secondary facial reanimation surgery (GFMT from the contralateral leg with innervation by the NTM) was performed due to lack of existing gracilis electrical stimulation and produced a successful smile noted at 7 months.
Conclusion:
This study demonstrates that successful salvage of a failed GFMT by CFNG is possible through transfer of the NTM to the obturator nerve even after 11 months.
