Facial Reanimation in Complete Moebius Syndrome Using Bilateral Free Gracilis Muscle Transfer: A Comparison of One-Stage Versus Two-Stage Procedures.

Abstract

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

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

Results: Eighteen CMS patients underwent 36 FGMT procedures: nine in Group 1 (one-stage) and nine in Group 2 (two-stage). The median age was 15 years (6-36 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 surgeries (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 free gracilis muscle transfer (FGMT) is as effective as the two-stage approach in CMS patients. The one-stage procedure is more cost-effective, with shorter surgeries, reduced hospital stay, and lower patient costs. Both surgical methods demonstrated similar long-term aesthetic and functional outcomes.