title: [Double innervation (facial/masseter) on the gracilis flap, in the middle face reanimation in the management of facial paralysis: a new concept].
abstract: BACKGROUND
  The facial paralysis is a non-rare condition that has very disabling functional, morphological and psychological repercussions. The current gold standard in facial reanimation is revascularized re-innervated muscle transfers.
  
  
  METHODS
  In this paper, we report the results of a new method using the gracilis flap with a double innervation on the masseter motor nerve and the controlateral facial nerve via a sural graft in a single stage intervention, on a series of six patients.
  
  
  RESULTS
  No failure was observed. The average delay of a voluntary contraction was 3.8months, and 7.2months for a spontaneous one. Three of the six patients had "excellent" results according to the Terzis and Noah classification, two were classified as "good" and one "average".
  
  
  CONCLUSIONS
  A choice is to be made between a method advocating a natural and spontaneous dynamicity (controlateral facial nerve stimulus) and a method focusing on the quality and quantity of contractions (ipsilateral trijeminal stimulus). In this new technique, we combine the two methods: a free gracilis transfer with a dual innervation on the healthy controlateral facial nerve via a sural graft, on one hand, and a second anastomosis on the ipsilateral masseter nerve, on the other hand.
  
  
  CONCLUSIONS
  This new proposed method seems to be, according to our results, a reliable technique rallying voluntary contraction and emotional smile.
authors: Maxillo-Facial Surgical Unit, San Paolo Hospital, University of Milan, via A. di Rudini 8, 20142 Milano, Italie.
authors: F
authors: F
authors: Biglioli
authors: W
authors: W
authors: Bayoudh
authors: V
authors: V
authors: Colombo
authors: M
authors: M
authors: Pedrazzoli
authors: D
authors: D
authors: Rabbiosi
mesh_terms: D005152:Facial Muscles / Q000294:innervation / Q000503:physiopathology / Q000601:surgery*; D005158:Facial Paralysis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008406:Masseter Muscle / Q000294:innervation / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D009119:Muscle Contraction; D018482:Muscle, Skeletal / Q000294:innervation / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012904:Smiling; D013524:Surgical Flaps / Q000294:innervation*; D013848:Thigh / Q000601:surgery; D016896:Treatment Outcome