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2008 Annual Meeting Abstracts

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LONG TERM OUTCOMES OF FREE MUSCLE TRANSFER FOR SMILE REANIMATION
Julia K. Terzis, M.D., Ph.D.1, Fatima Olivares, M.D.2.
1Eastern Virginia Medical School, Norfolk, VA, USA, 2MRC, Eastern Virginia Medical School, Norfolk, VA, USA.

PURPOSE:
Microneurovascular muscle transfer has been the main treatment for established facial paralysis over the last 25 years 1,2. Yla-kotola et al 3 carried out one of the very few studies available on long term outcomes of a free muscle. This report was primarily on adult patients and showed that the longer the follow up the poorer the function of the free muscle. The purpose of this study is to present the late outcomes of free muscle transfer and its possible influence on the growing skeleton in the pediatric population.
METHODS:
From 1981 to 2007, 153 patients underwent free muscle transfer for mid-face reanimation, of which 59 (61 free muscles) had a follow up longer than 5 years. This population included 33 children and 26 adults. According to the length of follow up available, patients were divided into 4 subgroups; Group A (n= 25) 5-6 years; Group B (n= 16) 7 to 10 years; Group C (n= 12) 11 to 15 years; Group D (n=7) follow up > 15 years . Four independent observers individually rated patients’ standardized videos; preoperatively, at 2 years post-free muscle transfer, and long term. The Terzis’ Grading System was used, which incorporates a 5 category scale from poor to excellent. Observers were asked to grade any disharmony between facial soft tissue and the growing skeleton in the pediatric population, and whether the outcomes at the two years video worsened with time. Significance level was set as 0.05.
RESULTS:
The rate scores in all patients increased after free muscle in comparison with the preoperative state. The scores further increased on the long term evaluation (p<.05) compared to early rates after free muscle. When the four groups were compared against each other, groups C & D did not show worse results than groups A & B (p<.05). In 77 % of the evaluations, the 4 observers agreed that there was no disharmony noticeable between the craniofacial skeleton growth and the transplanted muscle.
CONCLUSION:
In contrast to previous reports, this clinical data showed progressive improvement of free muscle function over a twenty year follow up. The transplanted muscle graft seems to grow harmoniously with the expanding facial skeleton, and its function is maintained over time. This is the first study that investigates the fate of free muscle transfer over a long time period in the pediatric population.


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