Plastic Surgery Research Council

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A Systemic Review of Dual Innervated Gracilis Muscle for Facial Reanimation Using Cross Face Nerve Graft and Masseteric Nerve
Thanapoom Boonipat, Jesse Mailke, MD, Krishna Vyas, MD PhD, Samir Mardini, MD.
Mayo Clinic, Rochester, MN, USA.

PURPOSE:
Dynamic facial reanimation is the gold standard treatment for a paralyzed face. The use of cross face nerve graft (CFNG) in combination with the masseteric nerve to innervate free gracilis muscle has been reported, with the goal of providing both spontaneity from the CFNG and strong innervation from the masseteric nerve. We systematically reviewed and summarized the outcomes of these techniques. METHODS:
A comprehensive search of the Ovid EMBASE, MEDLINE, Cochrane, and Scopus databases was performed from 1946 to July 2018 for dual innervation of gracilis muscle using CFNG plus masseter nerve for facial reanimation. Two independent reviewers screened the full texts to identify relevant articles.After data extraction from included studies, meta-analysis was performed to compare outcome parameters defining functional outcomes. RESULTS:
Six of 20 articles from 2012-2018 met criteria. The results are summarized in Table 1. A total of 48 patients were reviewed (mean age of 42.1 years (6-79 years)). The majority of dual innervations procedures were performed using CFNG as end-to-side coaptation and masseteric nerve as end-to-end. In the 26 patients that Terzis scores were available, most achieved good to excellent results, with no differences between CFNG as end-to-side and masseteric nerve as end-to-end or the reverse coaptation. All but two patients achieved function of gracilis activated by masseter within 2-5 months. CONCLUSION:
This systematic review demonstrates inconsistent results using current available dual innervation techniques, with the masseter providing the majority of the innervation. Meta analyses of comparative outcomes are limited by inconsistent methods of objective evaluation among authors.


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