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30-05-2011 | Article

Free gracilis transfer successfully improves smiling in children


Free abstract

MedWire News: Transferring the gracilis muscle in facial reanimation has an acceptable success rate in children, research shows.

Using the gracilis muscle also significantly improves smiling and quality of life with respect to facial function, report Tessa Hadlock (Harvard Medical School, Boston, Massachusetts, USA) and colleagues in the Archives of Facial and Plastic Surgery.

The gracilis muscle is the most widely used muscle transferred to the face to restore the muscle for facial reanimation.

That said, free tissue transfer for facial reanimation is plagued with inconsistent results, and has earned a reputation as a surgery that does not work, write the authors.

Because of these inconsistent results, parents and surgeons face a challenging task when deciding on operations for children, especially since failure rates can be as high as 30%.

For the current study, Hadlock and colleagues quantified gracilis muscle excursion in 17 pediatric patients undergoing 19 consecutive pediatric free gracilis transplantations between 2004 and 2009.

The cause of paralysis varied among patients, including 10 patients who were paralyzed because of a brain tumor.

The researchers used a validated program to assess functional outcomes. Briefly, postoperative photographs of the children in repose and smiling were analyzed for commissure excursion and compared with a cohort of 17 adults undergoing free gracilis operations.

Following surgery, the mean commissure excursion improvement was 8.8 mm, a finding that was similar to improvements observed in the adult facial reanimation series.

Defining a surgical failure as less than a 2-mm excursion, just two children had a complete surgical failure. On the other hand, four adults had failed surgery.

Measurements assessing quality of life also revealed a statistically significant improvement compared with pre-intervention quality-of-life scores.

The researchers point out that the inability to express emotions with facial movements can have serious social consequences, especially for children recovering from treatment following a central nervous system tumor resulting in paralysis.

"Because it carries a lower failure rate than a similar cohort of adult patients, there is no need to wait until patients reach adulthood to offer dynamic reanimation," according to Hadlock and colleagues.

Expressing themselves nonverbally through smiling may lead to fewer negative social consequences as they interact with friends, they add.

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By MedWire Reporters