title: Facial reanimation with gracilis muscle transfer neurotized to cross-facial nerve graft versus masseteric nerve: a comparative study using the FACIAL CLIMA evaluating system.
abstract: BACKGROUND
  Longstanding unilateral facial paralysis is best addressed with microneurovascular muscle transplantation. Neurotization can be obtained from the cross-facial or the masseter nerve. The authors present a quantitative comparison of both procedures using the FACIAL CLIMA system.
  
  
  METHODS
  Forty-seven patients with complete unilateral facial paralysis underwent reanimation with a free gracilis transplant neurotized to either a cross-facial nerve graft (group I, n=20) or to the ipsilateral masseteric nerve (group II, n=27). Commissural displacement and commissural contraction velocity were measured using the FACIAL CLIMA system. Postoperative intragroup commissural displacement and commissural contraction velocity means of the reanimated versus the normal side were first compared using the independent samples t test. Mean percentage of recovery of both parameters were compared between the groups using the independent samples t test.
  
  
  RESULTS
  Significant differences of mean commissural displacement and commissural contraction velocity between the reanimated side and the normal side were observed in group I (p=0.001 and p=0.014, respectively) but not in group II. Intergroup comparisons showed that both commissural displacement and commissural contraction velocity were higher in group II, with significant differences for commissural displacement (p=0.048). Mean percentage of recovery of both parameters was higher in group II, with significant differences for commissural displacement (p=0.042).
  
  
  CONCLUSIONS
  Free gracilis muscle transfer neurotized by the masseteric nerve is a reliable technique for reanimation of longstanding facial paralysis. Compared with cross-facial nerve graft neurotization, this technique provides better symmetry and a higher degree of recovery.
  
  
  METHODS
  Therapeutic, III.
authors: Pamplona, Spain From the Department of Plastic and Reconstructive Surgery, Clinica Universidad de Navarra.
authors: Bernardo
authors: B
authors: Hontanilla
authors: Diego
authors: D
authors: Marre
authors: Álvaro
authors: Á
authors: Cabello
mesh_terms: D000328:Adult; D004576:Electromyography; D005152:Facial Muscles / Q000294:innervation* / Q000601:surgery*; D005154:Facial Nerve / Q000503:physiopathology* / Q000601:surgery*; D005158:Facial Paralysis / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008406:Masseter Muscle / Q000294:innervation*; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D018482:Muscle, Skeletal / Q000294:innervation* / Q000637:transplantation*; D009416:Nerve Regeneration / Q000502:physiology; D016067:Nerve Transfer / Q000379:methods*; D012016:Reference Values; D012086:Reoperation; D020858:Tissue and Organ Harvesting / Q000379:methods