Facial Nerve Reanimation Using Free-functioning Gracilis Muscle Transfer in Adolescent Patients. Long-term Follow-up With Outcome Assessment Using House-Brackmann Facial Nerve Grading System.

Abstract

Facial nerve palsy is a condition that carries significant consequences, especially when it occurs during adolescence. It represents a considerable clinical problem due to limited treatment options, as well as the fact that it has significant cosmetic and functional implications. In adolescents with persistent facial palsy, microsurgical procedures for dynamic facial reanimation may effectively restore facial symmetry. A commonly performed intervention is free-functioning muscle transfer. The study group includes 10 pediatric patients aged 11 to 17 with diagnosed persistent facial nerve palsy, surgically treated for the restoration of mimic muscle function between 2018 and 2022. All patients included in the study underwent surgical treatment using free-functioning muscle transfer. The average observation period was 38 months (range: 21-54mo). To objectively assess the return of function of the transferred innervated muscle flap during treatment and postoperative recovery, the House-Brackmann Facial Nerve Grading System was used. At an average observation period of 38 months, at least grade 3 according to the HBGS scoring system was demonstrated in all cases. Twelve months after the procedure, 6 patients (60%) were classified as grade 3, and in 4 cases (40%), the achieved symmetry was sufficient to obtain grade 2. No patient reported limitations in the adduction of the lower limb resulting from the harvest of the gracillis muscle. Further research should focus on patient-reported outcomes, conducting studies on a large study group could lead to the development of a clinical algorithm that could facilitate the assessment and effectively assist in the treatment of facial palsy.