title: Use of the submental vessels for free gracilis muscle transfer for smile reanimation.
abstract: Free muscle transfer is an important in dynamic facial reanimation; however, suitable donor vessels in this population can be inadequate. In this case series, the submental vessels were used as donors to free gracilis muscle in vessel-depleted patients.
  
  
  
  Five patients underwent free gracilis muscle transfer for smile reanimation, 2 with a prior failed free gracilis transfer, 2 with vascular anomalies, and 1 with previous distal ligation of the facial vessels. The submental artery was used as a donor in all cases, and the submental vein was used in 3 cases.
  
  
  
  There were no complications or flap failure. Postoperative arterial and venous blood flow was confirmed in all patients using Doppler color flow imaging above and below the anastomoses.
  
  
  
  The submental vessels are suitable for microvascular anastomosis for free flaps having short pedicles, such as the free gracilis muscle flap, in the vessel-depleted hemiface. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-E2503, 2016.
authors.affiliation: Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania. ngoyal1@hmc.psu.edu.
authors.forename: Neerav
authors.initials: N
authors.lastname: Goyal
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
authors.forename: Nathan
authors.initials: N
authors.lastname: Jowett
authors.affiliation: Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee.
authors.forename: Sunshine
authors.initials: S
authors.lastname: Dwojak
authors.affiliation: Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Cunane
authors.affiliation: Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: Zander
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
authors.forename: Tessa A
authors.initials: TA
authors.lastname: Hadlock
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Emerick
mesh_terms: D002648:Child; D000072226:Computed Tomography Angiography; D005155:Facial Nerve Diseases / Q000601:surgery*; D005158:Facial Paralysis / Q000601:surgery*; D005260:Female; D000071976:Gracilis Muscle / Q000098:blood supply / Q000000981:diagnostic imaging / Q000637:transplantation*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D012904:Smiling; D055815:Young Adult
keywords: gracilis flap; smile reanimation; submental artery; vessel depleted