Hand Surgery and MicrosurgeryMuscle Transplants for Facial Reanimation Rationale and Results of Insertion Technique Using the Palmaris Longus TendonFaria, José Carlos M. MD; Scopel, Gean P. MD; Alonso, Nivaldo MD; Ferreira, Marcus C. MDAuthor Information From the Division of Plastic Surgery, University of Sao Paulo Medical School, São Paulo, Brazil. Received March 27, 2008, and accepted for publication, after revision, August 5, 2008. Reprints: José Carlos M. Faria, MD, Rua Maestro Cardim, 377, 8° Andar, CEP 01323-000 São Paulo, Brazil. E-mail: [email protected]. Annals of Plastic Surgery: August 2009 - Volume 63 - Issue 2 - p 148-152 doi: 10.1097/SAP.0b013e3181893867 Buy Metrics Abstract Thirty-one patients with unilateral long-standing facial palsy underwent 1-stage reanimation with free gracilis muscle transplant innervated by the masseteric branch of the trigeminal nerve. They were divided into 2 nonrandomized groups according to insertion technique: group I (9 patients), interrupted suture between the free flap and the orbicularis oris of the upper and lower lip on the paralyzed side; group II (22 patients), palmaris longus tendon graft placed between the gracilis free flap and the orbicularis oris of the upper and lower lip on the nonparalyzed side. Qualitative evaluation of the smile demonstrated better results in patients from group II. Comparing the position of the Cupid's bow at rest, pre- and postoperatively in each patient, we observed significant improvement of facial symmetry in both groups. During smile, however, there was a significantly higher rate of centralization of the Cupid's bow in patients submitted to reanimation with the use of the palmaris longus tendon (group II). © 2009 Lippincott Williams & Wilkins, Inc.