Secondary Dynamic Midface Reanimation with Gracilis Free Muscle Transfer after Failed Reconstruction Attempt: a 15-Year Experience

The quantitative outcome of secondary reanimation after failed primary reconstruction attempt of facial paralysis is rarely reported in the literature. This study aims to investigate the feasibility of secondary reanimation with gracilis free muscle transfer (GFMT) and whether this outcome is influenced by the primary reconstruction. Twelve patients with previously failed static procedures (static group, n=6), temporal muscle transfer (temporal transfer group, n=2), and GFMT (GFMT group, n=4) were all secondarily reanimated with GFMT. The clinical outcome was graded with the eFACE metric. The objective oral commissure excursion was measured with Emotrics and the artificial intelligence software FaceReader evaluated the intensity score (IS) of emotional expression. The mean follow-up was 40 ± 27 months. The eFACE metric showed a statistically significant (p