{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T04:10:08Z","timestamp":1784693408221,"version":"3.55.0"},"reference-count":31,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T00:00:00Z","timestamp":1641859200000},"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":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The choice of neurotization source for gracilis neuromuscular transplant is a key point in the treatment of unilateral long\u2010standing paralysis. To combine the advantages of different donor nerves and overcome their disadvantages, mixed neurotization sources have been described with encouraging results. The authors present a preliminary report of a novel technique, the \u201csupercharged\u201d cross\u2010graft, a two\u2010step technique consisting of a double powered cross nerve graft provided by a zygomatic branch of the healthy facial nerve and the masseter nerve of the healthy side.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and methods<\/jats:title><jats:p>From January 2015 to December 2019 eight patients, aged between 19 and 61\u2009years old (mean age at surgery 33.62) suffering unilateral established paralysis (congenital or acquired, &gt;24\u2009months) underwent gracilis reinnervation with the supercharged cross grafting technique. Subjects underwent a two\u2010step surgical rehabilitation: in the first operation sural nerve was harvested and used as cross\u2010graft cooptated by healthy side facial nerve branch and masseteric nerve. During second procedure gracilis neuromuscular transplant was performed reinnervarting the muscle with the cross\u2010graft. Patients were evaluated using Emotrics software, which allowed for automated facial measurements on post\u2010operative pictures taken at the last follow\u2010up. The results of the different poses were compared to assess the contribution to smile excursion by the masseter and facial nerve, together and separately. Finally, we analyzed spontaneous smile to assess whether masseteric contribution is used in daily life.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>No major or minor complications occurred. Follow\u2010up time ranged from 12 to 41\u2009months, with a mean of 22.75\u2009months. A good commissure excursion (mean 33.84\u2009mm) was obtained during smile with no teeth clenching (without masseter activation), as well as during teeth clenching without smiling (activation of gracilis only \u2013 mean 32.55). When smiling and biting simultaneously the excursion was greater than the single two components (mean 35.91). In spontaneous smile, commissure excursion was higher (mean 34.23) than that provided by only the facial nerve (smile only) in most patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This novel technique of mixed neurotization for gracilis transplant shows consistent results with powerful contraction and good smile coordination. It also allows us to extend the indications for mixed neurotization techniques.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.30849","type":"journal-article","created":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T12:23:01Z","timestamp":1641903781000},"page":"231-238","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Supercharged massetric\u2010facial cross\u2010graft for gracilis reinnervation in unilateral facial palsy treatment"],"prefix":"10.1002","volume":"42","author":[{"given":"Bernardo","family":"Bianchi","sequence":"first","affiliation":[{"name":"Maxillo\u2010Facial Surgery Unit, Head and Neck Department University Hospital of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1646-0509","authenticated-orcid":false,"given":"Michela","family":"Bergonzani","sequence":"additional","affiliation":[{"name":"Maxillo\u2010Facial Surgery Unit, Head and Neck Department University Hospital of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrica","family":"Stella","sequence":"additional","affiliation":[{"name":"Maxillo\u2010Facial Surgery Unit, Head and Neck Department University Hospital of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4906-6567","authenticated-orcid":false,"given":"Giuseppe","family":"Perlangeli","sequence":"additional","affiliation":[{"name":"Maxillo\u2010Facial Surgery Unit, Head and Neck Department University Hospital of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"De Stefani","sequence":"additional","affiliation":[{"name":"Unit of Neuroscience, Department of Medicine and Surgery University of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Sesenna","sequence":"additional","affiliation":[{"name":"Maxillo\u2010Facial Surgery Unit, Head and Neck Department University Hospital of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2297-1150","authenticated-orcid":false,"given":"Andrea","family":"Ferri","sequence":"additional","affiliation":[{"name":"Maxillo\u2010Facial Surgery Unit, Head and Neck Department University Hospital of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,1,11]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2011.07.019"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.23300"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2013.12.013"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcms.2017.03.021"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOO.0b013e32834fa744"},{"key":"e_1_2_8_7_1","first-page":"30272","article-title":"Dual innervation of free gracilis muscle for facial reanimation: What we know so far","volume":"29","author":"Boonipat T.","year":"2020","journal-title":"Journal of Plastic, Reconstructive & Aesthetic Surgery"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2005.09.003"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000001327"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000005871"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamafacial.2019.1090"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2018.07.003"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamafacial.2014.163"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000000905"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2017.01.050"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000001273"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2019.07.015"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e318230c58f"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamafacial.2018.0030"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcms.2016.06.031"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31828bd4da"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000002034"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2004-823124"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12434"},{"key":"e_1_2_8_25_1","first-page":"3489420957371","article-title":"Early outcomes in an emerging facial nerve center: The Oregon Health and Science University (OHSU) experience","volume":"11","author":"Krane N. 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