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Gossett et al. Plast Aesthet Res 2021;8:60 Plastic and
DOI: 10.20517/2347-9264.2021.69
Aesthetic Research

Review Open Access

Innervation options for gracilis free muscle transfer
in facial reanimation

2
1
Katherine Gossett , David Chen , Myriam Loyo 3
1
Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA.
2
Division of Facial Plastic and Reconstructive Surgery Department of Otolaryngology - Head and Neck Surgery, University of
Arizona, Tuscon, AZ 85724, USA.
3
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Oregon Health &
Science University, Portland, OR 97239, USA.
Correspondence to: Dr. David Chen, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head
and Neck Surgery, University of Arizona, 1501 N. Campbell Avenue, Tuscon, AZ 85724, USA. E-mail: chenda@musc.edu
How to cite this article: Gossett K, Chen D, Loyo M. Innervation options for gracilis free muscle transfer in facial reanimation.
Plast Aesthet Res 2021;8:60. https://dx.doi.org/10.20517/2347-9264.2021.69

Received: 18 Jun 2021 First Decision: 20 Aug 2021 Revised: 11 Sep 2021 Accepted: 20 Oct 2021 Published: 5 Nov 2021

Academic Editors: Mark K. Wax, Ruben Yap Kannan Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Gracilis free muscle transfer (GFMT) is considered the gold standard in dynamic smile reanimation in patients with
long-standing facial paralysis. There are multiple motor nerves in the head and neck that can be used to provide
innervation to the GFMT, either alone or in combination. In this article, we review the literature about these donor
nerve options and discuss their advantages and disadvantages in terms of smile excursion, spontaneity, reliability,
and timing. Furthermore, we discuss the use of multiple donor nerve sources in dually-innervated GFMT and areas
for future investigation.

Keywords: Facial paralysis, facial reanimation, gracilis free muscle transfer, masseteric nerve, cross facial nerve
graft

INTRODUCTION
Facial paralysis is a devastating condition that can lead to significant psychological distress and functional
[1]
and aesthetic impairment . The management of facial paralysis focuses on restoring symmetry to the face at
rest and with facial expressions. In the lower face, smile restoration is a key element of dynamic facial

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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