Simultaneous Reconstruction of The Lower Lip with Gracilis Functioning Free Muscle Transplantation (FFMT) for Facial Reanimation: Comparison of Different Techniques

Background: Functioning free muscle transplantation (FFMT) is currently the gold standard for the reconstruction of facial paralysis, focusing more on the upper lip reconstruction rather than the lower lip. This study aimed to compare different lower lip reconstructive methods when performing FFMT for facial reanimation. Materials and Methods: Retrospective review of FFMT for facial reanimation from 2007 to 2015 was performed. Patients were divided into three groups: Group 1 (n=15), a free plantaris tendon graft anchored to the gracilis muscle was passed into the lower lip to create a loop within; Group 2 (n=12), an aponeurosis tail of the gracilis muscle was attached to the lower lip; Group 3 (n=18), no suspension of lower lip was performed. All patients had at least two years of follow-up. Outcomes were assessed by photos and videos, including subjective evaluation of midline deviation and horizontal tilt and objective analysis of smile dimensions and area. Results: A total of 45 patients were included. Results from the subjective evaluation demonstrate group 1 patients having the best improvement (overall score: p=0.004 & 0.005, Fisher's exact test). The objective evaluation showed group 1 and 2 patients with better results compared to group 3 (Horizontal component p=0.009, vertical component p=0.004, and area distribution p

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