Single-Stage Reanimation of Oral Commissure Excursion and Lower Lip Depression by Dual-Vector Free Gracilis Muscle Transfer
Nate Jowett, MD, Harvard Medical School / Massachusetts Eye and Ear, Boston, MA and Tessa A Hadlock, MD, Facial Nerve Center - Dept. of Otolaryngology, Harvard Medical School / Massachusetts Eye and Ear Infirmary, Boston, MA
Single-Stage Reanimation of Oral Commissure Excursion and Lower Lip Depression by Dual-Vector Free Gracilis Muscle Transfer
Introduction:
Free muscle transfer in smile reanimation targets oral commissure excursion and upper lip elevation. In many patients, dentition show smile is not achieved secondary to superior malposition of the lower lip.
Materials & Methods:
A novel technique of dual-vector gracilis harvest and inset for single-stage reanimation of oral commissure excursion and lower lip depression with volitional smile is described, together with postoperative results in five patients.
Results:
Active depression of the lower lip during reanimated smile was achieved with favorable upper dentition show. No loss of lip sensation occurred.
Conclusions:
Single-stage dual-vector reanimation of oral commissure excursion and lower lip depression carries promise of improved smile outcomes for patients with unilateral facial palsy undergoing free muscle transfer.
Figure 1. Left – Full-effort smile in patient with right-sided postparalytic facial palsy prior to reanimation surgery. Center – Configuration of dual-vector free gracilis immediately prior to inset and coaptation to the nerve-to-masseter muscle. Left – Postoperative volitional smile result four months following transfer demonstrating favorable smile aesthetics.
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