Facial Plast Surg 2016; 32(02): 199-208
DOI: 10.1055/s-0036-1582248
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Gracilis Free Muscle Transfer in the Treatment of Pediatric Facial Paralysis

Pundrique R. Sharma
1   Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
,
Ronald M. Zuker
1   Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
,
Gregory H. Borschel
1   Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
› Author Affiliations
Further Information

Publication History

Publication Date:
20 April 2016 (online)

Abstract

Facial paralysis in children is a disabling functional and aesthetic issue. In cases where recovery is not expected, there are numerous options for reconstruction of the midface “smile.” At the Hospital for Sick Children in Toronto, Canada, we have been using a free functional gracilis muscle transfer. In this article, we review the technical details of the procedure, which we have refined over the past 30 years, and also briefly discuss secondary and adjunctive procedures.

 
  • References

  • 1 Labbé D. Lengthening of temporalis myoplasty and reanimation of lips. Technical notes [in French]. Ann Chir Plast Esthet 1997; 42 (1) 44-47
  • 2 Klebuc M. The evolving role of the masseter-to-facial (V-VII) nerve transfer for rehabilitation of the paralyzed face. Ann Chir Plast Esthet 2015; 60 (5) 436-441
  • 3 Lamas G, Gatignol P, Barbut J, Bernat I, Tankéré F. Hypoglossofacial anastomosis for facial palsy treatment: indications and results [in French]. Ann Chir Plast Esthet 2015; 60 (5) 430-435
  • 4 Snyder-Warwick AK, Fattah AY, Zive L, Halliday W, Borschel GH, Zuker RM. The degree of facial movement following microvascular muscle transfer in pediatric facial reanimation depends on donor motor nerve axonal density. Plast Reconstr Surg 2015; 135 (2) 370e-381e
  • 5 Biglioli F, Colombo V, Tarabbia F , et al. Recovery of emotional smiling function in free-flap facial reanimation. J Oral Maxillofac Surg 2012; 70 (10) 2413-2418
  • 6 Placheta E, Wood MD, Lafontaine C , et al. Enhancement of facial nerve motoneuron regeneration through cross-face nerve grafts by adding end-to-side sensory axons. Plast Reconstr Surg 2015; 135 (2) 460-471
  • 7 Gur E. Facial palsy: different generations. Presented at: Annual meeting of the American Society of Reconstructive Microsurgery; January 16–19, 2016; Scottsdale, AZ
  • 8 Harii K, Ohmori K, Torii S. Free gracilis muscle transplantation, with microneurovascular anastomoses for the treatment of facial paralysis. A preliminary report. Plast Reconstr Surg 1976; 57 (2) 133-143
  • 9 Manktelow RT, Zuker RM. Muscle transplantation by fascicular territory. Plast Reconstr Surg 1984; 73 (5) 751-757
  • 10 Banks CA, Hadlock TA. Pediatric facial nerve rehabilitation. Facial Plast Surg Clin North Am 2014; 22 (4) 487-502
  • 11 Rubin LR. The anatomy of a smile: its importance in the treatment of facial paralysis. Plast Reconstr Surg 1974; 53 (4) 384-387
  • 12 Rubin LR. The anatomy of the nasolabial fold: the keystone of the smiling mechanism. Plast Reconstr Surg 1999; 103 (2) 687-691 , discussion 692–694
  • 13 Harii K, Ohmori K, Sekiguchi J. The free musculocutaneous flap. Plast Reconstr Surg 1976; 57 (3) 294-303
  • 14 Mathes SJ, Nahai F. Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg 1981; 67 (2) 177-187
  • 15 Fattah AY, Ravichandiran K, Zuker RM, Agur AM. A three-dimensional study of the musculotendinous and neurovascular architecture of the gracilis muscle: application to functional muscle transfer. J Plast Reconstr Aesthet Surg 2013; 66 (9) 1230-1237
  • 16 Borschel GH, Kawamura DH, Kasukurthi R, Hunter DA, Zuker RM, Woo AS. The motor nerve to the masseter muscle: an anatomic and histomorphometric study to facilitate its use in facial reanimation. J Plast Reconstr Aesthet Surg 2012; 65 (3) 363-366