{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T03:51:46Z","timestamp":1784001106290,"version":"3.55.0"},"reference-count":15,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,3,30]],"date-time":"2018-03-30T00:00:00Z","timestamp":1522368000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>Facial paralysis has a profound impact on functionality and esthetics of the oral region. In patients with strong skin laxity and soft tissue ptosis, functional smile reconstruction is challenging due to the accentuated asymmetry at rest. Thus, the purpose of the study was to analyze facial symmetry in this patient clientele following a combination of dynamic reanimation with fascial strips for static suspension compared to functional gracilis transfer alone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In 2014, we altered the single\u2010stage approach for microsurgical smile reconstruction in patients with significant soft tissue ptosis by adding fascia lata grafts for static support. We evaluated 6 patients (mean age 57.8\u2009\u00b1\u20095.2, group A) who underwent the combined procedure, and compared their results to 6 patients with flaccid facial paralysis who were treated before 2014 and received a functional gracilis transfer alone (mean age 52.5\u2009\u00b1\u20097.5, group B). To test the efficacy of the technique, we retrospectively analyzed the correction of the oral asymmetry as well as nasal and philtral deviation by computer\u2010assisted photograph analysis 6 months postoperatively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The comparative analysis revealed a significant postoperative improvement of the oral asymmetry (A: 90.0\u2009\u00b1\u20095.0% relative correction at rest vs. B: 62.6\u2009\u00b1\u200917.2%, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.05), nasal (A: 0.4\u2009\u00b1\u20090.2 vs. B: 0.7\u2009\u00b1\u20090.4 mm, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.05), and philtral deviation (A: 0.5\u2009\u00b1\u20090.6 vs. B: 2.8\u2009\u00b1\u20091.8 mm, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.05) in group A.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The combined procedure for dynamic facial reanimation allows for immediate correction of the oral asymmetry and improves overall outcome in patients with advanced soft tissue ptosis and oral asymmetry at rest.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.30324","type":"journal-article","created":{"date-parts":[[2018,3,31]],"date-time":"2018-03-31T05:43:05Z","timestamp":1522474985000},"page":"634-642","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Comparison of symmetry after smile reconstruction for flaccid facial paralysis with combined fascia lata grafts and functional gracilis transfer for static suspension or gracilis transfer alone"],"prefix":"10.1002","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1008-4522","authenticated-orcid":false,"given":"Jurij","family":"Kiefer","sequence":"first","affiliation":[{"name":"Department of Plastic and Hand Surgery Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg  Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Braig","sequence":"additional","affiliation":[{"name":"Department of Plastic and Hand Surgery Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg  Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan R.","family":"Thiele","sequence":"additional","affiliation":[{"name":"Department of Plastic and Hand Surgery Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg  Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holger","family":"Bannasch","sequence":"additional","affiliation":[{"name":"Department of Plastic and Hand Surgery Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg  Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. Bj\u00f6rn","family":"Stark","sequence":"additional","affiliation":[{"name":"Department of Plastic and Hand Surgery Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg  Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen U.","family":"Eisenhardt","sequence":"additional","affiliation":[{"name":"Department of Plastic and Hand Surgery Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg  Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,3,30]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000218798.95027.21"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamafacial.2013.2463"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2012.04.030"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2016.12.005"},{"key":"e_1_2_6_6_1","first-page":"223","article-title":"[Comparison of cross face nerve graft with masseteric nerve as donor nerves for free functional muscle transfers in facial reanimation surgery]","volume":"45","author":"Eisenhardt S. 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