Oyer SL, et al. - In this retrospective case series of 28 patients, researchers compared quantitative changes in oral commissure symmetry and smile excursion after temporalis tendon transfer (T3) and gracilis free muscle transfer. In facial paralysis, temporalis tendon transfer and gracilis free muscle transfer both improve oral commissure symmetry and excursion. Subjects treated with gracilis free muscle transfer seem to have a greater improvement in smile excursion and, on average, the excursion approximates the contralateral healthy side.

Methods

• This was a case series of 28 adults with unilateral facial paralysis seeking dynamic lower facial reanimation at a tertiary academic medical center between July 1, 2010 and July 30, 2014.
• From May 1, 2016 to June 30, 2016, data were analyzed.
• Main intervention analyzed was minimally invasive T3 (n = 14) vs gracilis free muscle transfer (n = 14).
• Measured symmetry of the oral commissure between the healthy and paralyzed sides in the horizontal, vertical, and angular dimension and excursion of the paralyzed commissure after reanimation vs the healthy commissure were the main outcomes analyzed.

Results

• Of the 28 patients, 19 (68%) were women; mean (SD) age was 51.7 (17) years.
• Researchers found that commissure symmetry during smile improved significantly for the T3 patients in the vertical and angular dimensions, and the gracilis free muscle transfer patients had significant improvement in the vertical and horizontal dimensions.
• It was noted that commissure excursion significantly improved in both groups following surgery, with a larger improvement seen in the gracilis free muscle transfer group (11.3 mm; 95% CI, 7.0 to 15.5 mm) vs the T3 group (4.8 mm; 95% CI, 0.2 to 9.3 mm), with a mean difference of 6.5 mm (95% CI, 0.7 to 12.4 mm; Cohen d, 0.86).
• Findings revealed that postoperative smile excursion of the paralyzed side was within 1.0 mm of the healthy side in the gracilis free muscle transfer group (95% CI, -2.1 to 4.0 mm).