Descriptive study and functional results of smile reanimation surgery in patients with facial palsy with gracilis flap in a tertiary hospital

Abstract

Surgery in facial palsy aims to restore the face's symmetry in rest as well as reanimation of the smile. Gracilis flap is a therapeutic option for patients with long-term facial palsy. Our objective is to describe evolution and functional results of patients treated surgically through gracilis transposition. 27 patients with chronic (> 12 months) unilateral facial palsy were treated with gracilis transposition to reanimate smile. Demographic information such as age, gender and personal history was gathered, as well as onset of facial palsy, affected side, etiology, date and kind of surgery, complications and initiation of movement. Functional results were evaluated with the Facial Disability Index and the smile item on the Sunnybrook Scale. Mean age was 50 years old and a slight prevalence of women over men and right-sided palsy over left was observed. Most prevalent etiology was iatrogenic after acoustic neuroma surgery (33.3%). Fifty-nine percent of palsies were less than 5 years old in evolution. Donor nerve most frequently used was the masseter (48%), followed by the cross-face sural nerve graft with masseter babysitter (33.4%) and lastly, cross-face nerve graft (18.6%). Four patients required a second reanimation surgery. Most common complication was scar retraction at the angle of the mouth. Majority of patients initiated smile around 2–4 months after surgery, being a complete or almost complete movement in 66.6% of patients. Facial Disability Index Global Score was less than 100/200 in 20% of patients and more than 150/200 in 44% of them. Functional results were good in more than half the patients, with mild-moderate facial disability. There is a tendency to associate the use of masseter donor with better smile movements and facial disability indexes, even though results are not statistically significant was scar retraction at the angle of the mouth.