Three-Dimensional Video Analysis of the Paralyzed Face Reanimated by Cross-Face Nerve Grafting and Free Gracilis Muscle Transplantation: Quantification of the Functional Outcome

Background: Surgeons have found it difficult to quantify facial paralysis and its improvement by reconstructive surgery. This article presents the results achieved by free functional muscle transplantation for reconstruction of the paralyzed face, registered by three-dimensional video analysis of facial movements. Methods: Of patients treated consecutively between 1997 and 2006, two groups were constituted: group 1 comprised 22 patients with reinnervation completed after a single cross-face nerve graft and a free gracilis muscle graft for reconstruction of the smile; group 2 comprised nine patients treated with two cross-face nerve grafts followed by a territorially differentiated gracilis muscle transplant for reconstruction of the smile and eye closure. Smiling with showing teeth, maximal showing of teeth, and closing the eyes as in sleep were analyzed in detail. Results: In group 1, static asymmetry was reduced from 12.19 ± 8.73 mm preoperatively to −1.84 ± 7.67 mm at 18 months postoperatively. Smile amplitude increased from 9 to 60 percent of that on the healthy side in 10 incomplete facial palsies of this group, and from 0 to 62 percent in eight functionally successful muscle grafts among 11 patients with complete lesions. In group 2, static asymmetry improved from 7.24 ± 12.64 mm to −5.36 ± 9.07 mm; the overcorrection was intentional. Movement was improved in eight cases. Smile amplitude reached 68 ± 43 percent of that on the normal side. Lagophthalmus improved from 7.21 ± 3.59 mm to 1.38 ± 2.49 mm. All improvements were statistically significant (p ≤ 0.05). Conclusions: Three-dimensional video analysis provided an exact quantitative documentation of the degree of facial palsy preoperatively and the reconstructed movements. The value of free functional gracilis muscle transplantation was demonstrated for both variations of the technique.

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