Related Experiment Video

Updated: Jan 7, 2026

Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer
19:53

Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer

Published on: March 1, 2015

106.3K

Outcomes and Innervation of Gracilis for Pediatric Facial Paralysis: A Systematic Review

Kaiwen Chen1, Shaun A Nguyen1, Warren B Chun1

  • 1Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.

The Laryngoscope
|December 30, 2025
PubMed

Insights

Gracilis free muscle transfer effectively restores smiles in children. Masseteric innervation yields stronger smiles, while cross-facial nerve grafts provide spontaneous ones.

Area of Science:

  • Plastic Surgery
  • Pediatric Surgery
  • Facial Reanimation

Background:

  • Facial paralysis in children requires reconstructive surgery.
  • Gracilis free muscle transfer is a common technique.
  • Optimizing innervation is key for functional outcomes.

Purpose of the Study:

  • To compare outcomes of different innervation techniques for gracilis free muscle transfer in pediatric facial reanimation.
  • To guide surgical decision-making for improved patient results.

Main Methods:

  • Systematic review of CINAHL, PubMed, and SCOPUS databases.
  • Included 15 retrospective studies of pediatric patients (≤18 years).
  • Analyzed outcomes: commissure excursion, asymmetry, satisfaction, complications.

Main Results:

  • Masseteric innervation showed greatest commissure excursion (6.1-8.6 mm).
  • Cross-facial nerve graft (CFNG) provided moderate excursion (4.6-6.9 mm).
  • High patient satisfaction (83-100%) and low complication rates observed.

Conclusions:

  • Gracilis free muscle transfer is a safe and effective option for pediatric facial reanimation.
  • Masseteric innervation offers volitional smiles; CFNG offers spontaneous smiles.
  • Dual-innervation provides a balance between volitional and spontaneous smile.
Abstract

Keywords:
cross‐facial nerve graftgracilis free muscle transfermasseteric nerve innervationpediatric facial paralysis

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