Segmental Gracilis Muscle Transfer for Smile in a Case of Möbius Syndrome

Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.

Facial paralysis causes significant morbidity and dynamic reconstruction aims to address functional, aesthetic, and psychological aspects of the impairment. Segmental gracilis muscle transfer is a reconstructive strategy used to restore smile function in a chronic injury, where nerve grafting or nerve transfers are no longer an option due to prolonged muscle atrophy or congenital causes. In this case, the patient presented with a congenital neurological disorder called Möbius syndrome, which involved complete bilateral paralysis of CN6, CN7 and partial paralysis of CN12. The patient’s inability to smile was due to the absence of facial muscles. A bilateral segmental muscle transfer was elected to reconstruct smile using the gracilis muscle with neurotization with the masseteric nerve. Often, patients with Möbius syndrome do not have a facial vein, as in this patient, and the transverse facial vein and the facial artery were utilized for vascular anastomosis. This video portrays the approach and technical details for performing a segmental gracilis muscle transfer using the donor masseteric nerve.

Standard:

Extended:

POSITION

Supine.

INCISION

Pre-auricular incision.

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