Free gracilis muscle transfer, full masseter transposition and McLaughlin procedure for the treatment of facial paralysis

Abstract

Background.- Various techniques have been described for the restoration of smile and to achieve symmetrical oral comissures in patients with facial paralysis. Techniques such as skin excisions com¬bined with suspension with facia strips and tempo-ralis muscle transposition have major disadvantages. Design.- Twelve patients with unilateral facial paralysis are presented: free gracilis muscle transfer was done in 4 patients. McLaughlin's procedure was performed in 4 patients and full masseter transposi¬tion was done in 4 patients. All patients were evalu¬ated on the same day by a detalied questionnaire filled both by the patient and surgeon. Results.- The overall results were satisfactory in all patients. Oral comissure symmetry was achieved in all patients with satisfactory muscle excursion. Bulky appearance in the cheek was observed in patients with free gracilis muscle transfer and depression over the angle of the mandible was seen in patients with full masseter transposition. Unilateral tongue atro¬phy, speech and swallowing disorders were present in two patients in whom the hypoglossus nerve was used for the innervation of gracilis muscle. Conclusion.- Our results obtained 2 years after the operation suggests that sophisticated techniques such as free muscle transfers may not be superior to the conventional techniques such as full masseter transposition or McLaughlin procedure in the treat¬ment of facial paralyses.