Revision Surgery Following Gracilis Transplantation for Pediatric Facial Reanimation
Notice bibliographique
Résumé
PURPOSE: Management of pediatric patients with facial paralysis is challenging, and numerous surgical techniques have been described for smile reconstruction. A free gracilis muscle transfer innervated by a cross-face nerve graft (CFNG) from the contralateral facial nerve or by the ipsilateral motor nerve to masseter (MNTM) is recognized as the gold standard for smile reconstruction owing to its reliable outcomes. Despite the ubiquity of this technique in the pediatric population, there are limited data regarding the rate of secondary surgery to improve the cosmesis, symmetry, or function of the reconstruction. The purpose of this study was to assess the occurrence and type of secondary surgical procedures following pediatric facial reanimation using gracilis muscle transplantation. METHODS: Following ethics board approval, a retrospective cohort study was performed and included children who underwent facial reanimation using free gracilis muscle transfer at our pediatric hospital between 1985 and 2014. Medical charts were reviewed to assess secondary surgical procedures performed at least 1 year following the initial reanimation surgery. Procedures related to early postoperative complications, including hematoma or infection, were excluded. Indications for surgical revision were subdivided into major revisions—which involved a non- or poorly functioning muscle transplant necessitating a new gracilis muscle transplant—and minor revisions, where muscle function was acceptable, but surgery was intended to improve cosmesis and/or symmetry. RESULTS: There were 261 cases of facial reanimation utilizing a free gracilis muscle transfer between 1985 and 2019. One hundred seventy-three unilateral (66%) and 88 bilateral (34%) reconstructions were performed. Fourteen patients, 7 male and 7 female, required surgical revision (5.4%). The mean time to revision was 2.5 years following the initial surgery. Among patients requiring revision, 10 had muscle transplants innervated by a CFNG, and 4 by the MNTM. There was no statistically significant difference in the rate of revision between CFNG and MNTM (7.7% versus 4.8%; P = 0.4). Minor revisions to improve cosmesis and symmetry were performed in 12 patients (4.6%). Only 2 patients (0.8%) required major revisions, in which the gracilis muscle from the primary surgery was removed and replaced with a new free functioning gracilis muscle. There was no significant difference in revision rate for patients undergoing unilateral versus bilateral procedures (6.8% versus 3.5%; P = 0.4). CONCLUSIONS: Our study supports the use of gracilis muscle transplantation as a reliable technique for smile reconstruction in pediatric facial palsy, with low rates of secondary revision. Secondary surgery is most often performed to improve cosmesis and/or symmetry, and major revisions requiring microvascular transplantation of new muscle transfer are rare.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».