Effectiveness and Safety of the Use of Gracilis Muscle for Dynamic Smile Restoration in Facial Paralysis: a Systematic Review and Meta-Analysis

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Publication date: Available online 24 May 2019

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Mélissa Roy, Joseph P Corkum, Prakesh S. Shah, Gregory H. Borschel, Emily S. Ho, Ronald M. Zuker, Kristen M. Davidge

ABSTRACT

Background

Smiling is a fundamental component of social interactions. For patients with facial palsy, significant challenges arise. One of the key procedures for dynamic smile restoration is the microneurovascular transfer of a gracilis muscle. We aimed to assess the effectiveness and safety of dynamic smile reanimation surgery using the free gracilis muscle unit in patients with facial palsy.

Methods

We conducted a systematic review and meta-analysis of studies reporting surgical outcomes of dynamic smile restoration using free gracilis muscles identified from EMBASE, Medline, and Web of Science databases from their inception to March 15th 2018. Two-stage screening and data extraction were performed by two independent reviewers. Pooled proportions were calculated using random-effects models.

Results

Thirty-one studies including 1,647 patients who underwent 1,739 free gracilis flaps were included. Twelve (38.7%) studies measured peri-operative smile excursion change using six different tools. Six of these studies were homogenous and were used in meta-analyses of smile excursion improvement which revealed a mean change of 7.5 mm (95%CI 6.0-9.0 mm, I2 86.7%) peri-operatively. Twenty (64.5%) studies reported peri-operative complications and pooled proportions of flap failures was of 2.9% (95%CI 1.3-4.5%, I2 47.7%).

Conclusions

Dynamic smile restoration using a free gracilis muscle may represent an effective procedure to regain oral commissure motion and is associated with an approximately 3% rate of flap failure. Masseteric nerve coaptations lead to larger improvements in peri-operative smile excursion (10mm) than with cross-facial nerve grafts (6.8mm). Future studies with homogeneous reporting of smile excursion and patient-reported outcome measures are needed.