Donor nerve selection in free gracilis muscle transfer for facial reanimation. A systematic review and meta-analysis of clinical outcomes
Jazyk angličtina Země Nizozemsko Médium print-electronic
Typ dokumentu metaanalýza, systematický přehled, časopisecké články, práce podpořená grantem
PubMed
37148809
DOI
10.1016/j.bjps.2023.04.014
PII: S1748-6815(23)00163-8
Knihovny.cz E-zdroje
- Klíčová slova
- Dual innervated free gracilis flap, Facial palsy, Facial reanimation, Free gracilis muscle transfer,
- MeSH
- faciální paralýza * chirurgie MeSH
- lidé MeSH
- musculus gracilis * transplantace MeSH
- senioři MeSH
- usmívání se fyziologie MeSH
- výraz obličeje MeSH
- zákroky plastické chirurgie * MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- práce podpořená grantem MeSH
- systematický přehled MeSH
BACKGROUND: One of the critical factors in facial reanimation is selecting the donor nerve. The most favored neurotizers are the contralateral facial nerve with a cross-face nerve graft (CFNG) and motor nerve to the masseter (MNM). A relatively new dual innervation (DI) method has shown successful results. This study aimed to compare the clinical outcomes of different neurotization strategies for free gracilis muscle transfer (FGMT). METHODS: The Scopus and WoS databases were queried with 21 keywords. Three-stage article selection was performed for the systematic review. Articles presenting quantitative data for commissure excursion and facial symmetry were included in meta-analysis, using random-effects model. ROBINS-I tool and Newcastle-Ottawa scale were used to assess bias and study quality. RESULTS: One hundred forty-seven articles containing FGMT were systematically reviewed. Most studies indicated CFNG as the first choice. MNM was primarily indicated in bilateral palsy and in elderly. Clinical outcomes of DI studies were promising. 13 studies including 435 observations (179 CFNG, 182 MNM, 74 DI) were eligible for meta-analysis. The mean change in commissure excursion was 7.15 mm (95% CI: 4.57-9.72) for CFNG, 8.46 mm (95% CI: 6.86-10.06) for MNM, and 5.18 mm (95% CI: 4.01-6.34) for DI. In pairwise comparisons, a significant difference was found between MNM and DI (p = 0.0011), despite the superior outcomes described in DI studies. No statistically significant difference was found in resting and smile symmetry (p = 0.625, p = 0.780). CONCLUSIONS: CFNG is the most preferred neurotizer, and MNM is a reliable second option. Outcomes of DI studies are promising, but more comparison studies are needed to draw conclusions. Our meta-analysis was limited by incompatibility of the assessment scales. Consensus on a standardized assessment system would add value to future studies.
Department of Anatomy Faculty of Medicine Masaryk University Brno Czech Republic
Department of Biostatistics Faculty of Medicine Hacettepe University Ankara Turkey
Masaryk University Campus Library Masaryk University Brno Czech Republic
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