Background: Surgical treatment of long-term facial palsy has been reported using various techniques, including functioning muscle-free flaps. The free gracilis muscle flap is the most common because of its many advantages. Our study presents a modified way of shaping the gracilis muscle for transfer to the face to improve the restoration of natural smiles.

Methods: This retrospective study assessed 05 patients who received the classical technique and 43 patients who received modified, U-shaped, free gracilis muscle flap for smile reanimation from 2013 to 2020. The surgery is single staged. Preoperative and postoperative photos were taken. Functional outcomes were evaluated using the Terzis and Noah score and the Chuang smile excursion score.

Results: The mean patient age at the time of operation was 31 years. The length of gracilis muscle harvested was 12_13 cm. Of the 43 patients who received U-shaped design free gracilis muscle, results were excellent for 15 (34.9%), good for 20 (46.5%), and fair for 8 (18.6%) followed Terzis and Noah score. The Chuang smile excursion score was 2 for 16.3%, 3 for 46.5%, and 4 for 37.2% of 43 patients. Of the 05 patients who underwent classical technique, there are no excellent results base on Terzis and Noah score. The Chuang smile excursion score was only 1 and 2.

Conclusions: The U-shaped modification to the gracilis muscle-free flap is a simple and effective technique to help restore a symmetrical and natural smile in patients with facial palsy.

 

Keywords: Gracilis muscle, facial palsy, smile reanimation, Terzis and Noah score, Chuang smile excursion score