Functional Outcome Comparison of Free Gracilis Muscle Anchoring Methods in Patients with Facial Paralysis: Upper Lip Red Line Incision versus Facelift Incision Approach

Hojin Park; Dae Won Hong; Tae Suk Oh

doi:10.1055/s-0042-1744309

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2023; 39(01): 027-034
DOI: 10.1055/s-0042-1744309

Original Article

Functional Outcome Comparison of Free Gracilis Muscle Anchoring Methods in Patients with Facial Paralysis: Upper Lip Red Line Incision versus Facelift Incision Approach

Authors

Hojin Park

¹Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Dae Won Hong

¹Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Tae Suk Oh

¹Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

Abstract

Background The greatest challenge of a free-muscle transfer in facial reanimation surgery is anchoring muscle to perioral soft tissue. An additional incision provides a better way to anchor the transferred muscle but leaves a visible scar. Herein, we compared the functional and aesthetic outcomes in a conventional facelift incision approach with and without the addition of a red line incision.

Methods This study included patients experiencing unilateral facial paralysis who underwent free gracilis transfer between December 2016 and December 2018. Anchoring through facelift incision with extended neck incision was performed in the control group, while a red line incision was added in the red line group by avoiding extended neck incision. Oral commissure excursion, upper lip and commissure height differences, and symmetry were measured.

Results A total of 24 patients met the criteria and were included in this study. Of these, 10 patients were assigned to the red line group and 14 to the control group. The red line and control groups demonstrated a similar symmetry index in both resting (0.96 ± 0.18 and 0.92 ± 0.10, respectively; p = 0.435) and smiling (0.94 ± 0.12 and 0.91 ± 0.10, respectively; p = 0.314). However, the upper lip height difference demonstrated greater postoperative improvement (resting: 2.12 ± 1.13 vs. 3.92 ± 1.41 mm, p = 0.002, and smiling: 1.68 ± 0.88 vs. 3.41 ± 1.69 mm, p = 0.004, respectively). A scar could be easily concealed on the mucocutaneous line of the lip.

Conclusion This novel method for muscle anchoring in facial reanimation surgery allows surgeons to approach perioral muscle more directly. This leads to improved surgical results by securely anchoring the transferred muscles using a fixation point that is more medially located than in other approaches. Our method is effective and offers an improved surgical outcome for the free functional gracilis muscle transfer.

Keywords

facial paralysis - gracilis muscle - facial asymmetry - facial expression

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Referenzen

References
1 Zuker RM. Facial paralysis and the role of free muscle transplantation. Ann Chir Plast Esthet 2015; 60 (05) 420-429
2 Kim MJ, Oh TS. A nasolabial fold reset technique for enhancing midface lifts in facial reanimation: Three-dimensional volumetric analysis. J Craniomaxillofac Surg 2020; 48 (02) 162-169
3 Chuang DC, Lu JC, Chang TN, Laurence VG. Comparison of functional results after cross-face nerve graft-, spinal accessory nerve-, and masseter nerve-innervated gracilis for facial paralysis reconstruction: the Chang Gung experience. Ann Plast Surg 2018; 81 (6S Suppl 1): S21-S29
4 Lee KN, Koh KS. Acellular human dermis, a good option for correcting the free border deficiency in secondary cleft lip deformity. J Plast Reconstr Aesthet Surg 2012; 65 (03) 356-361
5 Guarin DL, Dusseldorp J, Hadlock TA, Jowett N. A machine learning approach for automated facial measurements in facial palsy. JAMA Facial Plast Surg 2018; 20 (04) 335-337
6 Pessa JE, Zadoo VP, Garza PA, Adrian Jr EK, Dewitt AI, Garza JR. Double or bifid zygomaticus major muscle: anatomy, incidence, and clinical correlation. Clin Anat 1998; 11 (05) 310-313
7 Garcia RM, Gosain AK, Zenn MR, Marcus JR. Early postoperative complications following gracilis free muscle transfer for facial reanimation: a systematic review and pooled data analysis. J Reconstr Microsurg 2015; 31 (08) 558-564
8 Chuang DC, Lu JC, Chang TN, Hamdi Sakarya A. Using the “sugarcane chewing” concept as the directionality of motor neurotizer selection for facial paralysis reconstruction: Chang Gung experiences. Plast Reconstr Surg 2019; 144 (02) 252e-263e
9 Grasseschi MF. Minimal scar repair of unilateral cleft lip. Plast Reconstr Surg 2010; 125 (02) 620-628
10 Jowett N, Hadlock TA. Free gracilis transfer and static facial suspension for midfacial reanimation in long-standing flaccid facial palsy. Otolaryngol Clin North Am 2018; 51 (06) 1129-1139
11 Bhama PK, Park JG, Shanley K, Hadlock TA. Refinements in nasolabial fold reconstruction for facial paralysis. Laryngoscope 2014; 124 (12) 2687-2692
12 Kannan RY, Neville C, Nduka C. Vermilion-mucosal advancement flap: a scarless technique of adynamic wedge resection of the lower lip in patients with facial palsy. JAMA Facial Plast Surg 2018; 20 (05) 423