Workhorse Free Functional Muscle Transfer Techniques for Smile Reanimation in Children with Congenital Facial Palsy: Case Report and Systematic Review of the Literature |
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Authors: | Konstantinos Gasteratos Saif Al Azzawi Nikolaos Vlachopoulos Ioana Lese Georgia-Alexandra Spyropoulou Adriaan O Grobbelaar |
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Institution: | 1. Plastic and Reconstructive Surgery Department, Papageorgiou General Hospital, Thessaloniki, Greece;2. Microsurgery Fellow, Royal Adelaide Hospital, Port Rd, Adelaide SA 5000, Australia;3. Melbourne Institute of Plastic Surgery, Malvern, Victoria 3144 Australia;4. Department of Plastic and Reconstructive Surgery, St Thomas'' Hospital, Westminster Bridge Road, London SE7 1EH, United Kingdom;5. Graduate of the Aristotle University of Thessaloniki, School of Medicine -Hellenic Military Academy of Combat Support Officers, Thessaloniki, Greece;6. Department of Plastic and Hand Surgery; Inselspital, Bern University Hospital, Bern, Switzerland;7. Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom;8. Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom;9. Department of Plastic and Hand Surgery; Inselspital, Bern University Hospital, Bern, Switzerland;10. Professor at University College of London, Division of Surgery and Interventional Science, London, United Kingdom |
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Abstract: | BackgroundPediatric facial palsy represents a rare multifactorial entity. Facial reanimation restores smiling, thus boosting self-confidence and social integration of the affected children. The purpose of this paper is to present a systematic review of microsurgical workhorse free functional muscle transfer procedures with emphasis on the long-term functional, aesthetic, and psychosocial outcomes.Materials and methodsWe performed a literature search of the PubMed database from 1995 to 2019 using the following search strategy: "facial paralysis"Title/Abstract] OR "facial palsy"Title]. We used as limits: full text, English language, age younger than 18 years, and humans. Two independent reviewers performed the online screening process using Covidence. Forty articles met the inclusion criteria. The protocol was aligned with the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and was registered at the International Prospective Register of Systematic Reviews (PROSPERO, CRD42019150112) of the National Institute for Health Research.ResultsFree functional muscle transfer procedures include mainly segmental gracilis, latissimus dorsi, and pectoralis minor muscle transfer. Facial reanimation procedures with the use of the cross-face nerve graft (CFNG) or masseteric nerve result in almost symmetric smiles. The transplanted muscle grows harmoniously along with the craniofacial skeleton. Muscle function and aesthetic outcomes improve over time. All children presented improved self-esteem, oral commissure opening, facial animation, and speech.ConclusionsA two-stage CFNG plus an FFMT may restore a spontaneous emotive smile in pediatric facial palsy patients. Superior results of children FFMT compared to adults FFMT are probably attributed to greater brain plasticity. |
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