{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T02:26:17Z","timestamp":1788575177556,"version":"build-2803163510"},"reference-count":28,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,5,17]],"date-time":"2022-05-17T00:00:00Z","timestamp":1652745600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Free functional muscle transfer has become the criterion standard for the treatment of long\u2010standing flaccid facial paralysis. Clinical experience suggests that a two\u2010stage approach using a cross\u2010face nerve graft (CFNG) as a donor nerve for free functional muscle transfers (FFMT) is less successful in older patients when compared to the pediatric population. However, clear data and scientific evidence are still rare. This study examines the age\u2010related outcome of CFNG\u2010driven FFMT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty\u2010eight patients with a mean age of 20.73\u2009years (ranging 5\u201351\u2009years) who received two\u2010stage facial reanimation with CFNG\u2010driven gracilis FFMT at our institution from 1998 to 2019 were included. The ipsilateral sural nerve was used as CFNG. After 12\u2009months, the ipsilateral gracilis muscle was used as FFMT. Patients were distributed equally into three cohorts according to their age. We assessed facial symmetry before and after facial reanimation measuring the angle between the interpupillary and the intermodiolar line (pupillo\u2010modiolar angle). Additionally, the commissure height was measured using the Emotrics software.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean follow\u2010up of the pediatric, young adults and the middle\u2010aged cohort was 29.5\u00a0\u00b1\u20097.3, 24.9\u00a0\u00b1\u20096.3, and 25.5\u00a0\u00b1\u200912.4\u00a0months, respectively. One patient suffered flap loss due to flap ischemia. Four patients suffered insufficient innervation of the FFMT. Otherwise no major complication occurred. The likelihood of successful innervation of the FFMT was significantly higher in patients younger than 31\u2009years (100% vs. 50%; <jats:italic>p<\/jats:italic>\u00a0=\u2009.003). Smiling facial symmetry (pupillo\u2010modiolar angle) significantly improved in the pediatric cohort (5\u201316\u2009years; 8.68\u00b0\u2009\u00b1\u20090.69\u00b0 to 1.48\u00b0\u2009\u00b1\u20090.67\u00b0; <jats:italic>p<\/jats:italic>\u00a0&lt;\u2009.001) and the young adults' cohort (17\u201330\u2009years; 11.55\u00b0\u2009\u00b1\u20091.95\u00b0 to 4.62\u00b0\u2009\u00b1\u20091.08\u00b0; <jats:italic>p<\/jats:italic>\u00a0=\u2009.005), but improved only slightly in the middle\u2010aged cohort (31\u201351\u2009years; 11.77\u00b0\u2009\u00b1\u20091.16\u00b0 to 9.4\u00b0\u2009\u00b1\u20091.8\u00b0 <jats:italic>p<\/jats:italic>\u00a0=\u2009.27). The postoperative smiling symmetry showed a significant correlation with increasing age (<jats:italic>r<\/jats:italic>\u00a0=\u2009.62, <jats:italic>p<\/jats:italic>\u00a0&lt;\u2009.001). The smiling commissure height deviation significantly improved in the pediatric cohort (5\u201316\u2009years; 6.5\u20132.3\u2009mm; <jats:italic>p<\/jats:italic>\u00a0=\u2009.006) and the postoperative result was significantly better than the middle\u2010aged group (31\u201351\u2009years; 2.3 vs. 7.5\u2009mm; <jats:italic>p<\/jats:italic>\u00a0=\u2009.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The outcome of CFNG\u2010driven gracilis FFMT is age\u2010related. Static as well as dynamic facial symmetry after two\u2010stage facial reanimation was best in the pediatric and young adult population. For older patients, other approaches like the nerve\u2010to\u2010masseter\u2010driven FFMT should be considered.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.30896","type":"journal-article","created":{"date-parts":[[2022,5,17]],"date-time":"2022-05-17T11:29:06Z","timestamp":1652786946000},"page":"557-567","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Age\u2010related outcome of facial reanimation surgery using cross face nerve graft and gracilis free functional muscle transfer\u2014A retrospective cohort study"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1574-9589","authenticated-orcid":false,"given":"Jakob B. W.","family":"Weiss","sequence":"first","affiliation":[{"name":"Department of Plastic and Hand Surgery, University of Freiburg Medical Center Medical Faculty of the University of Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicitas","family":"Spuerck","sequence":"additional","affiliation":[{"name":"Department of Plastic and Hand Surgery, University of Freiburg Medical Center Medical Faculty of the University of Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6668-7798","authenticated-orcid":false,"given":"Branislav","family":"Kollar","sequence":"additional","affiliation":[{"name":"Department of Plastic and Hand Surgery, University of Freiburg Medical Center Medical Faculty of the University of Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen U.","family":"Eisenhardt","sequence":"additional","affiliation":[{"name":"Department of Plastic and Hand Surgery, University of Freiburg Medical Center Medical Faculty of the University of Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,5,17]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000218798.95027.21"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.1920140909"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2016.12.005"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00381-018-3974-8"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamafacial.2019.1090"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamafacial.2014.163"},{"key":"e_1_2_10_8_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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