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Research Original Investigation

Powering the Gracilis for Facial Reanimation

Table. Summary of Studies Reporting Outcomes for Gracilis Muscle Transfer a

Reported Postoperative Outcome Measures Excursion and Symmetry Spontaneity

Newcastle Ottawa

Score (of 9)

Length of Follow-up 9 mo for MN; 18 mo for CFNG

Study Design Location

No. of Stages

Mean Age, y

Other

Source Bhama et al, 11 2014 Biglioli et al, 7 2012 Biglioli et al, 7 2012 Braig et al, 23 2017

Donor Nerve

Retro spective cohort

Boston, Massachusetts

66 MN; 52 CFNG; 6 MN + CFNG; 1 ipsilateral VII

Single for MN; double for CFNG

35.0 FACEgram NA

NA

8

NA

18 mo

8

Case series

Milan, Italy

4 MN + CFNG Single

49.4 Terzis and Noah Grade

Recorded movement during funny movie Recorded movement during funny movie

NA

12 mo

8

Single

42.3 Terzis and Noah Grade

Milan, Italy

10 MN; 40 latissimus (excluded)

Retro spective cohort Retro spective cohort Retro spective cohort Retro spective cohort Retro spective cohort Retro spective cohort Retro spective cohort

NA

Revision rate

20 mo

8

36.2 Tragion

Freiburg, Germany

14 MN; 8 CFNG Single for MN; double for CFNG

commissure distance

NA

>40 mo

8

Hontanilla et al, 12 2016

Single

43.6 FACIAL CLIMA

Questionnaire, funny home video

Pamplona, Spain

36 MN; 30 contralateral MN transfer (excluded) 18 dominant VII branch

Lin et al, 24 2011

Taoyuan, Taiwan

Single

43

Terzis and Noah Grade

NA

NA

>24 mo

7

8

NA

FaCE survey

<6 mo for MN; 12-18 mo for CFNG

37.8 FACEgram, Sunnybrook Facial Grading Scale 46.6 FACEgram, Terzis and Noah Grade

Boston, Massachusetts

8 MN; 12 CFNG Single for MN; double for CFNG

Lindsay et al, 25 2014

Oh et al, 26 2019

NA

NA

15 mo

8

Single for both

Seoul, South Korea

3 MN; 7 MN + CFNG (combined both groups in results) 5 MN; 6 CFNG; 3 MN + CFNG; 14

43.5 FACEgram NA

Revision rate

Not stated 8

Oyer et al, 27 2018 Uehara et al, 13 2018

Single for MN; double for CFNG

Baltimore, Maryland

temporalis (excluded)

Physician observation

CMAP >12 mo

7

Case series

Oita, Japan

6 MN + CFNG Single

56.7 Oral

commissure excursion, angle measurement

Abbreviations: CFNG, cross-facial nerve graft; CMAP, compound motor unit action potential; MN, masseteric nerve; NA, not applicable. a Discrepancies in reported numbers of patients in each group due to patients being excluded from analysis.

Figure 2. Meta-analysis of Studies Assessing Oral Commissure Excursion After Reanimation With Gracilis Powered by Cross-Facial Nerve Graft vs Masseteric Nerve

Favors Cross Facial Nerve

Favors Masseteric Nerve

Weight, %

Study

SMD (95% CI)

Bhama et al, 11 2014

0.68 (0.22 to 1.14)

71.62

Lindsay et al, 25 2014

0.34 (–0.56 to 1.24)

18.57

Oyer et al, 27 2018

0.05 (–1.19 to 1.29)

9.82

Overall a

0.55 (0.17 to 0.94)

100

–2

–1

SMD (95% CI) 0

1

2

SMD indicates standardized mean difference.

to fill out a questionnaire to determine whether they ob served spontaneous smiling. One study 13 did not use any objective measures, and reported the results of physician observation during follow-up visits. Two retrospective studies 12,28 found that 1 of 10 (10%) and 20of 36 patients (56%)

Spontaneity Four studies 7,12,13,28 including 56 patients examined the rate of achieving a spontaneous smile. Three studies 11,25,28 showed patients a funny movie, and observed them for spontaneity, graded as yes vs no. One study 12 also asked family members

432 JAMA Otolaryngology–Head & Neck Surgery May 2020 Volume 146, Number 5 (Reprinted)

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