title: Long-term outcomes of free muscle transfer for smile restoration in children.
abstract: BACKGROUND
  Evaluation of long-term outcomes of free-muscle transfer for smile restoration is overdue. Arguments for and against free-muscle transplantation in children are considered, and the debate on the influence of the growing skeleton on muscle function is revisited. This study evaluated the fate of free-muscle transfer over long follow-up periods in pediatric patients.
  
  
  METHODS
  Thirty-two children with follow-up of 5 years or longer who received a free-muscle transfer for smile restoration were reviewed. To better analyze the effect of time, patients were classified into groups based on the length of follow-up: group A, 5 to 6 years; group B, 7 to 10 years; group C, 11 to 15 years; and group D, more than 15 years. Patients were videotaped at three stages: preoperatively, 2 years after free-muscle transfer, and at the last follow-up visit. Four independent observers graded patients' videotapes using a five-category scale ranging from poor to excellent. Panelists were asked to comment on any noticeable craniofacial disharmony with growth.
  
  
  RESULTS
  All patients exhibited improved function and symmetry at 2 years after free-muscle transfer (averaged scores, p < 0.0001). A positive effect of time was seen in the long-term evaluation; observers' scores (p < 0.0001) and motor units on electromyography (p = 0.001) showed further improvement. No significance was found when comparing measured outcomes among the four follow-up groups, indicating that despite the growing skeleton, muscle function was maintained over time.
  
  
  CONCLUSIONS
  These clinical data support the use of free-muscle transfer for smile restoration in children. The transplanted muscle appears to grow harmoniously with the craniofacial skeleton, and muscle function and aesthetic outcomes improved over time.
authors.affiliation: Norfolk, Va. From the International Institute of Reconstructive Microsurgery, Microsurgery Program, Department of Surgery, Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School.
authors.forename: Julia K
authors.initials: JK
authors.lastname: Terzis
authors.forename: Fatima S
authors.initials: FS
authors.lastname: Olivares
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004576:Electromyography; D005154:Facial Nerve / Q000601:surgery; D005158:Facial Paralysis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D018482:Muscle, Skeletal / Q000294:innervation / Q000502:physiology / Q000601:surgery*; D019651:Plastic Surgery Procedures; D020127:Recovery of Function; D012904:Smiling; D013524:Surgical Flaps