RESUMO
BACKGROUND: In facial reanimation, dual-innervated gracilis free functional muscle transfers (FFMTs) may have amalgamated increases in tone, excursion, synchroneity, and potentially spontaneity when compared with single innervation. The ideal staging of dual-innervated gracilis FFMTs has not been investigated. We aim to compare objective long-term outcomes following one- and two-stage dual-innervated gracilis FFMTs. METHODS: Included were adult patients with facial paralysis who underwent either one- (one-stage group) or two-stage (two-stage group) dual-innervated gracilis FFMT with ≥1 year of postoperative follow-up. Facial measurements were obtained from standardized photographs of patients in repose, closed-mouth smile, and open-mouth smile taken preoperatively, 1 year postoperatively, and 3 years postoperatively. Symmetry was calculated from the absolute difference between the paralyzed and healthy hemiface; a lower value indicates greater symmetry. RESULTS: Of 553 facial paralysis patients, 14 were included. Five and nine patients were in the one- and two-stage groups, with mean follow-up time, respectively, being 2.5 and 2.6 years. Within-group analysis of both groups, most paralyzed-side and symmetry measurements significantly improved over time with maintained significance at 3 years postoperatively in closed and open-mouth smile (all p ≤ 0.05). However, only the two-stage group had maintained significance in improvements at 3 years postoperatively in paralyzed-side and symmetry measurements in repose with commissure position (median change [interquartile range, IQR], 7.62 [6.00-10.56] mm), commissure angle (median change [IQR], 8.92 [6.18-13.69] degrees), commissure position symmetry (median change [IQR], -5.18 [-10.48 to -1.80] mm), commissure angle symmetry (median change [IQR], -9.78 [-11.73 to -7.32] degrees), and commissure height deviation (median change [IQR], -5.70 [-7.19 to -1.64] mm; all p ≤ 0.05). In the between-group analysis, all measurements were comparable in repose, closed-mouth smile, and open-mouth smile (all p > 0.05). CONCLUSION: Long-term outcomes demonstrate that both one- and two-stage dual-innervated gracilis FFMTs significantly improve excursion, but only two-stage reconstruction significantly improves resting tone.
RESUMO
BACKGROUND: Comparing long-term tone and excursion between single- versus dual-innervated free functional muscle transfer (FFMT) in patients with longstanding facial paralysis. METHODS: Longstanding facial palsy patients treated with a FFMT innervated either by a nerve-to-masseter (single-innervation group) or by nerve-to-masseter and cross-facial-nerve graft (dual-innervation group) were included. One year minimal follow up was required. Outcome measures, based on standardized photos, included excursion, smile angle, teeth exposure, commissure height deviation, and upper lip height deviation in repose and in closed and open teeth smile preoperatively, and at 3-months, 1-year, and 3-years postoperatively. Emotrics software (Massachusetts Eye and Ear Infirmary, Boston, MA) and ImageJ (Rasband, W.S., ImageJ, U.S, National Institutes of Health, Bethesda, MD) were used for measurements. Between group and within group longitudinal comparisons were analyzed. RESULTS: At three years (single=24, dual=13), significance was found between groups in commissure position (single=26.42mm, dual=31.51mm, p<0.0001) and excursion with open mouth smile (single=31.32mm, dual=26.59mm, p<0.001). Single-innervation FFMT within group analysis lacked significant improvement in commissure height deviation and upper lip height deviation at 3 years in repose, while dual-innervation group revealed significant improvements (3.67mm and p<0.001, 3.17mm and p<0.001 respectively). Teeth exposure revealed an increase in the dual-innervation group (single=35.753 mm 2, dual=64.177 mm 2), albeit significance was not observed. CONCLUSIONS: Dually innervated FFMT revealed improvements in resting tone and teeth exposure with minimal decrease in smile excursion compared with single innervated FFMT.