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Updated: Jul 12, 2026
Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer
Published on: March 1, 2015
Exploring the Role of Fascia Lata Suspension in Triple Nerve Transfer for Facial Reanimation: A Comparative Outcomes
Kenzo Alejandro Fukumoto-Inukai1, Damián Palafox1, Osmani Castillo-Garrido1
1Plastic and Reconstructive Surgery Department, Hospital General "Dr. Manuel Gea Gonzalez", Mexico City, Mexico.
Background:
Triple nerve transfer (TNT) combines cross-face nerve grafts, masseteric-to-facial nerve transfer, and hypoglossal-to-facial nerve transfer to restore facial function in long-standing facial paralysis. However, its efficacy in patients with severe soft tissue laxity or atrophy may be limited. This study evaluates whether adding autologous fascia lata suspension (TNTF) to TNT improves functional and psychosocial outcomes.
Methods:
A retrospective study compared 22 patients with chronic unilateral facial paralysis, treated with either TNT alone (n=14) or TNT plus fascia lata suspension (TNTF, n=8). All patients completed the Facial Clinimetric Evaluation (FaCE) Scale pre- and postoperatively (≥12 months). Statistical analyses included Wilcoxon signed-rank tests, Mann-Whitney U tests, ANCOVA, and repeated-measures ANOVA to adjust for baseline differences.
Results:
Both groups showed significant improvements in FaCE scores postoperatively (TNT: +18, p<0.001; TNTF: +24, p<0.01). The TNTF group had worse preoperative scores (median 25 vs. 37, p=0.006), but postoperatively, scores were comparable (49.1 vs. 55.1, p=0.095). The mean improvement was greater in TNTF (Cohen's d ≈ 0.82, p=0.09), with significantly greater gains in oral function and social appearance (e.g., FaCE item Q15: +3 vs. +1, p=0.02). Correlation between EMG severity and baseline FaCE scores was significant (ρ ≈ 0.57, p<0.01).
Conclusion:
TNT restores facial function, but adding fascia lata suspension improves static tone and symmetry in patients with severe soft tissue laxity, offering superior functional and psychosocial outcomes in complex cases.
