Bilateral simultaneous free gracilis muscle transfer: a realistic option in management of bilateral facial paralysis.

Abstract

Bilateral facial paralysis patients have oral incompetence, poor articulation, and dental caries. This problem is frequently addressed by performing staged gracilis transplants without specific oral sphincter reconstruction. The purpose of this study is to describe the technique of bilateral simultaneous free gracilis muscle transfer with oral sphincter reconstruction, for one-stage facial reanimation in patients with bilateral facial paralysis. Case series. One-stage bilateral gracilis transfer was performed in three patients with bilateral facial paralysis. Muscle transplants produced a meaningful smile in all transferred muscles. All patients reported improved speech and decreased drooling. Bilateral gracilis transplants with reconstruction of the oral commissure is a realistic option in management of the bilaterally paralyzed face. In this small series, it appears to improve oral competence, restore smiling, and contribute favorably to lower lip support. This technique has been made more feasible because the operative time for free tissue transfer has continuously declined with the use of two-team surgery, improved microsurgical techniques, and the advent of venous coupling devices.