Facial Reanimation in Moebius Syndrome Using Bilateral Free Gracilis Transfer: 1-Stage versus 2-Stage Procedures.

Background: Complete Moebius syndrome (MbS) is a congenital condition affecting cranial nerves VI and VII, causing bilateral facial paralysis and limited ocular abduction. Bilateral free gracilis muscle transfer (FGMT) is the standard treatment. Traditionally performed in 2 stages, a new 1-stage approach has been introduced at our center. This study compares the surgical and long-term outcomes of both methods in patients with complete MbS.

Methods: This retrospective cohort study included patients with MbS who underwent 1-stage or 2-stage bilateral FGMT between March of 2016 and June of 2024, with a median follow-up of 8.1 years (range, 2 to 19 years). The authors evaluated sociodemographic characteristics, perioperative and postoperative parameters, total costs, satisfaction, and long-term aesthetic and functional outcomes. Statistical analyses included chi-square and Mann-Whitney U tests, with significance set at P < 0.05.

Results: Eighteen patients with complete MbS underwent 36 FGMT procedures: 9 in group 1 (1-stage) and 9 in group 2 (2-stage). The median age was 15 years (range, 6 to 36 years), and 61.1% were women. No significant differences were observed in postoperative complications such as flap loss ( P = 0.303), hematoma ( P = 0.058), surgical-site infections ( P = 0.134), or flap revision ( P = 0.257). Group 2 had longer surgical procedures ( P = 0.050), extended hospital stays ( P = 0.001), and higher costs ( P = 0.001). Aesthetic and functional outcomes were similar between the groups ( P > 0.05).

Conclusions: One-stage bilateral FGMT is as effective as a 2-stage approach in patients with complete MbS. The 1-stage procedure is more cost-effective, with shorter surgical procedures, reduced hospital stay, and lower patient costs. Both surgical methods demonstrated similar long-term aesthetic and functional outcomes.

Clinical question/level of evidence: Therapeutic, III.