[Reconstruction of chronic facial paralysis by free gracilis muscle transfer. Apropos of 59 cases].

Surgical repair of facial paralysis is designed to restore automatic and uniform facial expression. The authors report their experience of 64 patients with longstanding facial paralysis treated by revascularized and reinnervated gracilis muscle transfer. Reinnervation of the gracilis muscle was obtained by anastomosis of its motor nerve to the facial nerve on the healthy side following preliminary transfacial nerve graft. 59 patients were followed for 1 to 8 years; the mean duration of facial paralysis was 14 years in this series. The authors modified the gracilis muscle harvesting technique by decreasing the muscle mass to a minimum. Two complications were observed: one severe infection leading to thrombosis of the anastomosed vessels and one intraoperative technical difficulty concerning the nerve anastomosis. The results were considered to be good in 72% of cases and excellent in 5% of cases in terms of facial expression. However, good results were not obtained in muscle transfer for palpebral paralysis, in which the authors prefer to make the eyelid heavier by inserting a gold weight implant after modifying this technique to lower the rejection rate.