Revision Surgery Following Gracilis Transplantation for Pediatric Facial Reanimation
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".