Free Muscle and Nerve Transfers for Facial Reanimation: Evaluating Techniques, Donor Nerve Selection and Outcomes for Smile Restoration

ანოტაცია

This comprehensive review examines Free functional muscle transfer (FFMT) techniques for facial reanimation, focusing on smile restoration in patients with long-term facial paralysis. Multiple neurotization techniques such as the Motor Nerve of Masseter (MNM), Cross-Facial Nerve Graft (CFNG), and Dual Innervation (DI) are explored in depth to clarify and understand the specific set of indications and advantages of each technique. A literature review was conducted using PubMed for articles published within the last 10 years. It was found that even though FFMT using the Gracilis muscle is the gold standard, DI strategies combining MNM and CFNG provide a balance of high smile excursion, resting tone and spontaneity, thus containing the advantages of both techniques. Pediatric patients demonstrate further advantages such as enhanced cortical adaptation often achieving spontaneous smiles even with MNM alone. In conclusion, careful patient selection, appropriate surgical timing, and donor nerve choice are crucial for successful FFMT outcomes. Limitations such as the heterogeneity in outcomes and non-standardized assessment methodologies restrict understanding of the area. Further research will benefit from long-term prospective studies with unified assessment modules, to directly compare and quantify  functional benefits.