Nerve sources for facial reanimation with muscle transplant in patients with unilateral facial palsy: clinical analysis of 3 techniques

Ninety-one patients with long-standing unilateral facial palsy and submitted to reanimation of the face with muscle transplant were divided into 3 nonrandomized groups: group I: 2-stage facial reanimation, cross face followed by gracilis muscle transplant, 58 patients; group II: 1-stage reanimation with latissimus dorsi muscle transplant, 11 patients (a branch of the facial nerve on the nonparalyzed side of the face was used as the nerve source for reanimation in groups I and II); group III: 1-stage reanimation with gracilis muscle transplant and neural coaptation of the respective nerve and the ipsilateral masseteric branch of the trigeminal nerve, 22 patients. No microvascular complications were observed. The average interval between surgery and initial muscle contractions was 11.1 months, 7.2 months, and 3.7 months in group I, group II, and group III, respectively. The quality (intensity and shape) of the smile, voluntary or involuntary, obtained on the reanimated side in relation to the unaffected side was considered good or excellent in 53.4%, 54.5%, and 86.3% of the patients in groups I, II, and III, respectively. In group I, the average age of the patients with excellent or good results (19.8 + 10.5 years) was significantly lower than that of the patients with fair or poor results or absence of movement (36.5 + 13.3 years). The smile was considered emotional or involuntary in 34% of the patients in group I and 45% in group II. Most of the patients in each group were only able to produce "voluntary smiles". Crossed synkinesis with lip puckering was observed in 48% of the patients in group I and 90% in group II. The results obtained with 1-stage facial reanimation with masseteric nerve were more uniform and predictable than those obtained with the other techniques evaluated in this study.