Long-Term Outcomes of Free Gracilis Muscle Transfer for Smile Reanimation in Children

J Pediatr. 2018 Nov;202:279-284.e2. doi: 10.1016/j.jpeds.2018.06.043. Epub 2018 Jul 25.


Objective: To evaluate long-term outcomes of free gracilis muscle transfer (FGMT) for smile reanimation on smile excursion, facial symmetry, and quality of life in a cohort of children with facial palsy.

Study design: A retrospective analysis of 40 pediatric patients who underwent FGMT for facial palsy at the Massachusetts Eye and Ear Infirmary Facial Nerve Center was performed. Preoperative and postoperative photography and videography were used to quantify smile excursion and facial symmetry. Preoperative and postoperative quality of life was assessed with the Facial Clinimetric Evaluation (FaCE) survey, a validated, patient-based instrument for evaluating facial impairment and disability.

Results: Of the 40 patients who underwent FGMT for facial palsy, 38 patients had complete data including preoperative and postoperative photography and videography from 3 months to 10 years following surgery; 13 cases had >5 years of follow-up. FGMT resulted in significant improvements in smile excursion within several months, with continued improvements in smile excursion and symmetry demonstrated more than 5 years later. Fifteen patients completed preoperative and postoperative FaCE surveys, which demonstrated significant improvement in quality of life scores following FGMT.

Conclusions: FGMT significantly improves smile, facial asymmetry, and quality of life for years after this surgery for facial palsy.

Keywords: facial paralysis; facial reanimation; free gracilis muscle transfer; gracilis; pediatric facial paralysis; smile reanimation.

MeSH terms

  • Academic Medical Centers
  • Adolescent
  • Boston
  • Child
  • Cohort Studies
  • Facial Expression
  • Facial Paralysis / diagnosis
  • Facial Paralysis / surgery*
  • Female
  • Follow-Up Studies
  • Gracilis Muscle / innervation
  • Gracilis Muscle / transplantation*
  • Humans
  • Male
  • Quality of Life*
  • Reconstructive Surgical Procedures / methods*
  • Retrospective Studies
  • Severity of Illness Index
  • Smiling*
  • Time
  • Treatment Outcome