Browsing by Author "Bali, ZU"
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Item The use of free helical rim flaps for the reconstruction of the ala nasi and lower eyelidBali, ZU; Aksoy, A; Yoleri, LAims and Objectives: The aim of this study was to present our experience using free flaps harvested from the helix in the reconstruction of the nose and lower eyelid. Materials and Methods: Between 2016 and 2019, 5 male and 2 female patients treated surgically with free helical flaps were included in the study. All defects had occurred due to tumor excision. Results: A total of two lower eyelid defects and five ala nasi defects were reconstructed using free helical rim flaps. Seven helical flaps based on the superficial temporal vessels were obtained and used for reconstruction. No recurrence was detected in any of the patients within the followup period. The only remarkable complication reported was dehiscence development, which was attributed to partial venous congestion in one patient. Free helical rim flaps are similar to the ala nasi and lower eyelids in terms of concave shape, tissue, and color. Conclusion: The results have shown that free helical rim flaps are a suitable option for use in the repair of appropriately sized fullthickness defects of the ala nasi and lower eyelid.Item Total nasal reconstruction with pre-laminated, super-thin anterolateral thigh flap: A case reportBali, ZU; Karatan, B; Parspanci, A; Tuluy, Y; Kececi, Y; Yoleri, LMany techniques for nasal reconstruction have been described to achieve aesthetically and functionally favorable results. Local tissues, specifically the forehead flap, provide the best tissue match with the nose. However, when local tissue donor sites are limited, alternative options such as free tissue transfers should be considered. Herein, we describe a case of a 72-year-old male patient who had a total nasal and left malar defect reconstructed with a two-staged, pre-laminated, super-thin anterolateral thigh (ALT) flap. The patient's nasectomy was performed 15 years ago. The adjacent left malar defect was due to recent squamous cell carcinoma excision. Local tissues were unavailable for reconstruction due to previous tumor excisions. For the 8.5 x 5 cm defect, a 12.5 x 8 cm ALT flap was planned, with 7.5 x 8 cm for nasal reconstruction and 5 x 4 cm for malar reconstruction. During the first stage, a super-thin fascial ALT flap was raised without dissecting the perforators, and the nasal skeleton was laminated between these two flaps. Costal cartilages were harvested for the nasal skeleton and positioned between the suprafascial and the fascial ALT flaps. During the second stage, two perforators were dissected to the pedicle on the pre-laminated flap, and the flap was divided from the donor site. The nasal skeleton was fixed and anastomosis with the facial vessels was established. After both stages, no complications were observed. After one month, a revision surgery was performed to enhance the transition between the reconstructed nose and the cheek, and improve the nasal projection. Postoperatively, after one year, the patient had a stable nasal reconstruction with good breathing. Prelaminated, super-thin ALT flaps provide the advantages of a wide and versatile donor site and an acceptable donor site scar. They may be an option for patients who are not amenable to traditional reconstruction methods.Item Inferior Gluteal Artery Perforator Flap for Closure of Sacral Defects after Pilonidal Sinus SurgeryBali, ZU; Ahmedov, A; Özkan, B; Mazican, M; Keçeci, YIntroduction: The aim of the current study was to introduce the use of the inferior gluteal artery perforator flap (IGAPF) as a new alternative surgical technique for closure of sacral defects after pilonidal sinus surgery. Patients and Methods: Inferior gluteal artery perforators were used on 15 male patients operated in the plastic and reconstructive surgery deportment of our tertiary care centers between March 2014 and May 2017. Age, size of the defect, duration of follow-up, complications, and recurrence rate were assessed. Results: The average age was 30.2 (range: 17-54) years, and the mean duration of follow-up was 8.2 (range: 7-16) months. No recurrence was detected within the follow-up period, and the only remarkable complication reported was total flap necrosis attributed to venous congestion in one patient. The mean size of the defects after excision was 21.6 cm(2). Conclusion: Our preliminary results imply that IGAPF can be a safe and effective alternative for closure of large defects after pilonidal sinus surgery. Further controlled trials on larger series are warranted to establish the advantages and disadvantages of this alternative technique.Item An effective technique for managing vascular diameter discrepancies in microsurgery: tapering with a hemoclipBali, ZU; Evrenos, MK; Karatan, B; Kececi, Y; Yoleri, LMicrovascular anastomosis is mandatory for free flap surgery, but free flap transfer can be challenging because of vascular diameter discrepancies during microsurgery. Different methods have been described for preventing vascular discrepancies. The aim of this study was to test a simple technique using a hemostatic clip to taper the vessels. In 12 patients who had free tissue transfer with diameter discrepancies between donor and recipient vessels, tapering with a hemostatic clip technique was used. After key sutures were placed on the vessels, a hemostatic clip was placed in an oblique fashion on the vessel with a larger diameter. After the vessel was tapered and the same diameters in the donor and recipient vessels were achieved, anastomosis was completed. This technique was used in head and neck reconstruction and lower extremity reconstruction. The luminal diameters of arteries, and veins of the flap and recipient differed by 1.6- to 3.0-fold and 1.5- to 2.6-fold, respectively. All the flaps survived without complications. Tapering with a hemoclip technique is a rapid procedure that can be considered for managing vascular diameter discrepancies in free tissue transfers.Item Modified Temporalis Muscle Flap for Eyelid ReanimationEvrenos, MK; Bali, ZU; Yaman, M; Yoleri, LThe reanimation of both upper and lower paralytic eyelids requires dynamic procedures for longevity of correction. Temporalis muscle ensures the criteria for reanimation and is used widely as a result. Many modifications were described to improve the success of the classical technique. One of these modifications was reported by the senior author in 1999. Twice as much muscle mass (in thickness) to the upper eyelid than the lower was taken and passed submuscularly 5 to 6 mm away from the limbus and a thinner split was passed subcutaneously beneath the lower cilia. The aim of this study was to present the outcomes of the technique after 38 operations with 37 patients and to describe deep temporalis musculofascial-fatty flap to recover depression of temporalis muscle split donor area. Seventeen lower eyelids were evaluated as mild, 12 were as moderate, and 9 were as severe ectropion. One upper eyelid was evaluated as mild, 14 were as moderate, and 23 were as severe lagophthalmos preoperatively. Mean follow-up time was 28.8 months. Five patients had mild ectropion and 2 patients had mild lagophthalmos postoperatively at last follow-up. Two patients needed medial canthal tendon reinsertion secondary to relaxation of fixation suture at medial canthus. All patients tolerated the procedure and all complaints were resolved without creating a notable cosmetic deformity.Item Free gracilis muscle flap: Variations of obturator nerveTuluy, Y; Bali, ZU; Unsal, MO; Parspanci, A; Yoleri, L; Kececi, YBackground: Gracilis muscle has been used in reconstructive surgery for free muscle flap transfer. It was reported to be a reliable flap with lower rates of donor-site morbidity. In this study, we aimed to emphasize the anatomical variations of the obturator nerve. Materials and Methods: Clinical results of 14 patients who underwent lower lip reconstruction and facial reanimation with free gracilis muscle transfer between March 2017 and May 2021 were examined. Results: We identified eight male and six female patients, with a mean age of 55.6 years (range: 37-73 years). Of 14 patients, nine (64.3%) were operated on for lower lip reconstruction, and the remaining five cases underwent facial reanimation. Despite adequate dissection, we could not find the branch of the obturator nerve for gracilis muscle in two cases (14.3%), while vascular pedicles are detected in all cases. The first case was a lower lip reconstruction and the second case was a facial reanimation. Conclusion: While gracilis muscle is a good option for functional muscle transfer, it may be difficult to find the branch of the obturator nerve. Our study may suggest the need for consideration of anatomical variations of the obturator nerve before surgical planning for improved shared decision-making.Item A Mother and Child with Moebius SyndromeBali, ZU; Usluer, A; Yoleri, LIn this case report, we present the case of a 25-year-old male with familial Moebius syndrome having facial nerve paralysis; his mother had both facial nerve paralysis and sixth cranial nerve paralysis. He was admitted to our outpatient clinic with complaints of an unclosed left eye and a sagging left corner of the mouth. During preoperative procedures for the operation for the correction of facial paralysis, we noticed that his mother also had peripheral facial nerve and ipsilateral sixth cranial nerve paralysis simultaneously. Either patient underwent examinations and research considering the familial Moebius syndrome and its clinical findings. The male patient was operated with a modified temporal muscle transposition technique for lagophthalmos and tendon graft hanging and cross facial nerve graft (CFNG) with the sural nerve for the sagging mouth corner.Item Reconstruction of burn contractures with free anterolateral thigh flap in various anatomic sitesBali, ZU; Özkan, B; Keçeci, Y; Ertas, N; Yoleri, LBACKGROUND: Burn contractures that cause a restriction in extremity movements have to be reconstructed. Free microvascular flaps are generally needed in cases of severe contractures. The ideal free flap for severe contracture defects has to have a large skin island without bulk and a long pedicle for preventing recurrence and tension-free adaptation. Anterolateral thigh flap (ALT flap) that meets these features has widely been used for several indications in reconstructive surgery. Usage of ALT flap in burn contracture was described for burn and axillary contractures in literature. In this study, the usage of free ALT flaps in various anatomic contracture sites was reported. METHODS: Fifteen free ALT flaps were performed in 14 (12 male, two female) patients with a mean age of 36.6. Burn contracture defects in neck, axilla, popliteal, cubital region, plantar foot and hand were reconstructed with ALT flap. RESULTS: No total flap loss was encountered. Distal flap necrosis was seen in one case. All patients had significant improvement in a range of motions. Recurrence in contracture was seen in one patient with hand flexor contracture due to lack of physical treatment. CONCLUSION: ALT flap can safely be used in various anatomic contracture sites. Suprafascial elevation of the flap can be preferred for better adaptation in the neck, hand and foot and prevention of bulky appearance.Item Preserving the Blood Flow of the Recipient Artery in Cross-Leg Free Flap Procedure for Lower Extremity ReconstructionBali, ZU; Karatan, B; Tuluy, Y; Kececi, Y; Yoleri, LWhen there is no suitable vessel in the injured leg for microsurgical transfer, cross-leg free flaps can be considered for lower extremity reconstruction. This report describes patients who experienced lower extremity trauma and underwent reconstruction with cross-leg free flaps with preserved blood flow in the recipient artery. Anterolateral thigh flap is preferred for small to moderate defects. The descending branch of the lateral femoral circumflex artery was dissected 2 cm proximally and distally and was prepared in a T-shape. The branches of the T were anastomosed to the recipient artery in the contralateral leg in the first session of the cross-leg free flap procedure. After 3 weeks, the flap artery was separated from the bifurcation. For large defects, the latissimus dorsi flap was chosen. The thoracodorsal artery was anastomosed to the contralateral posterior tibial artery in the first session. After 3 weeks, to provide recipient vessel integrity, the thoracodorsal artery was transected from the flap and anastomosed to the distal stump of the posterior tibial artery. Between January 2017 and January 2019, 8 defects were reconstructed using an anterolateral thigh flap; the remaining 4 defects were reconstructed using a latissimus dorsi flap. All flaps survived without complications. Anterograde flow distal to the anastomosis was confirmed in all recipient arteries via Doppler ultrasound. In cross-leg free flaps, the continuity of the recipient artery can be established to prevent diminished blood flow to the recipient extremity.Item Angular artery island flap for eyelid defect reconstructionKeçeci, Y; Bali, ZU; Ahmedov, A; Yoleri, LEyelid reconstruction is a challenging surgical procedure because of the special function and structure of the eyelids. There are various useful techniques which can be used to reconstruct eyelid defects. In this report, the authors aimed to present the clinical results of angular artery-based island flap for the repair of the full thickness eyelid defects. This presented series consists of eight patients with full-thickness eyelid defects. Oncologic resection was the reason for all of them. Five of the patients had lower eyelid defects and the other three had upper eyelid defects. Nasojugal angular artery-based axial flap was used in reconstruction in all patients. The inferior limit of the flap was the alar rim level in order to make the flap totally axial. A tunnel was created under the orbicularis oculi muscle in cases where the medial portion of the eyelids was left intact and healthy. Septal chondromucosal graft was used to repair posterior lamella of the eyelid. The follow-up period of the cases was from 12 months to 22 months, with a mean follow-up period of 16 months. There was only one patient with reconstructed upper eyelid needed flap defatting. There was no ectropion or wound healing problem observed during the follow-up period. This presented series shows that angular artery-based axial flap and septal chondromucosal graft combination is a simple and safe technique for both upper and lower eyelid full-thickness defect reconstruction. The donor site of this flap heals with an inconspicuous scar concealed in the nasojugal area.Item Dermoscopic features of trichilemmal carcinomaArslan, Z; Bali, ZU; Evrenos, MK; Temiz, P; Ermertcan, ATItem Nonsyndromic Giant Basal Cell Carcinoma With Follicular Differentiation and Multifocal Localized Basal Cell CarcinomaUsluer, A; Yoleri, L; Kandiloglu, AR; Bali, ZU; Demirer, O; Inanir, IBasal cell carcinoma is the most common malignant tumor of the skin. The most important feature is its very slow growth rate. It takes many years to reach gigantic dimensions. Various syndromes have been defined in which basal cell carcinoma exists in multiple localizations in a single patient. A case of basal cell carcinoma with multiple localizations and gigantic dimensions which is not classified as a syndrome is described in this case report.Item Comparison of Standard Open Wound Care and Vacuum-assisted Closure Therapy in Fournier's GangreneBali, ZU; Akdeniz, CB; Muezzinoglu, T; Üçer, O; Kara, EObjective: Management of Fournier's gangrene (FG) includes large wound debridement, broad-spectrum antibiotic, wound care and re-debridement if necessary. The aim of our study was to compare standard open wound care and vacuum-assisted closure (VAC) therapy in patients with FG. Materials and Methods: Thirty-three patients (29 males and 4 females) who underwent surgery for FG were enrolled in the present study. The data was evaluated retrospectively. The patients were divided into two groups according to wound care after large wound debridement. Standard open wound care with antibiotic pomade was performed twice a day in 14 patients arid VAC therapy was performed every 48-72 hours in 17 patients. The data of the two groups were compared. Results: Twenty-three (69.7%) patients had Diabetes Mellitus and 20 patients (60%) had poor hygiene. The re-debridement rate in patients who received standard open wound care was statistically higher than in those who underwent VAC therapy (p=0.016). There were no statistically significant differences in mortality rate, length of hospital stay and need for reconstruction between the groups. When the data were analyzed, no statistically significant difference was found in FG Severity index score, length of hospital stay and mortality rate. However, the relationship between mortality rate and location of lesion was statistically significant (p=0.03). Four patients died, 3 (75%) due to wide necrotizing fasciitis extending to the abdominal wall. Conclusion: The present study showed that the technique used for wound care did not influence mortality, need for reconstruction and length of hospital stay. The only advantage of VAC therapy was decreased re-debridement rate in patients with FG.Item Malignant Proliferating Trichilemmal Tumor: Clinical Presentations, Treatment, and OutcomesEvrenos, MK; Bali, ZU; Temiz, P; Ermertcan, AT; Yoleri, LBackground: Malignant proliferating trichilemmal tumor (MPTT) is very rare malignant tumors of hair follicles derived from outer root sheath. This tumor is mostly located on the head and neck of elderly women. Regional or distant metastasis is possible. In this study, we present clinical features and treatment outcomes of cases diagnosed as MPTT. Furthermore, we aimed to emphasize a different clinical form of the tumor that can be misdiagnosed clinically. Patients and Methods: A retrospective evaluation of five cases operated between September 2009 and February 2017 Celal Bayar University Faculty of Medicine, Plastic Reconstructive and Aesthetic Surgery Department at were included in the study. Clinicopathological features of patients, type of surgery, and follow-up information were evaluated. Results: Four patients were female. Average age was 72.2. All of the lesions were located on the head and neck. All patients had a history of rapid growth of lesions. Patients were scanned with computed tomography. There was no metastasis at the time of diagnosis. None of the patients needed adjuvant therapy. Mean follow-up time was 11.8 months. None of the patients developed recurrence or metastasis. Conclusions: These tumors resemble basal cell or squamous cell carcinoma. Rapid progress of benign form of the tumor should address malignant transformation. There is no consensus about adjuvant therapy. Screening for metastasis and close follow-up are mandatory.Item Reconstruction of lower lip defects with free super-thin anterolateral thigh flapBali, ZU; Ozkan, B; Parspanci, A; Kececi, Y; Yoleri, LBackground Lower lip is a vital organ with important functions as well as aesthetic importance. It is critical to provide an aesthetically appealing lower facial subunit with maintenance of understandable speech and oral competence. Achieving these targets is very difficult especially in total lower lip defects. This report presents a technique using super-thin anterolateral thigh (ALT) flaps with fascia graft for reconstruction of large, complex oral sphincter defects. Patients and methods Six patients with squamous cell carcinoma (SCC) and one patient with a gunshot injury were presented in this report. All of them had full-thickness defects including skin, orbicularis muscle and oral mucosa. The mean age was 58 (range, 32-85) years. Defects of the lower lip were reconstructed with a super-thin ALT flap. Super-thin flaps were obtained by planning as close to the knee as possible and elevating at the level of superficial fascia. The fascia graft was used for achieving lip suspension. Results Overall flap survival was 100%. The flap size ranged from 8 x 6 cm to 14 x 10 cm. The follow-up periods ranged from 6 to 14 months. All the patients achieved acceptable oral competence, both in the resting condition and during speaking and eating, except for one patient who had a drooping lower lip developed in the post-operative 3rd month and underwent a secondary tightening procedure. Another patient needed liposuction due to bulky appearance. Conclusion Super-thin ALT flaps seem to be a useful option for functional and aesthetic reconstruction of extensive lip defects.Item Anterolateral Thigh Flap Design by Using Suprafascial Course of the PerforatorBali, ZU; Keçeci, Y; Pabuscu, Y; Yoleri, LObjectives Recently, anterolateral thigh flap has become one of the most commonly used free flaps in reconstructive surgery. Although its pedicle has relatively sufficient length, it falls short in some circumstances. Eccentric perforator location can be used to lengthen the pedicle, but flap tip viability can be a problem in this case. In addition, partial flap loss can be encountered in perforator flaps. The aim of this study was the use of multidetector computed tomographic angiography in preoperative mapping to overcome these problems. Materials and Methods Anterolateral thigh perforator flap was planned for various soft-tissue reconstructions in 19 patients. There were 15 males and 4 female patients with ages ranging from 19 to 65 years. These patients were evaluated with preoperative multidetector computed tomographic angiography to choose and to trace the course of the perforators. Flaps were designed according to the suprafascial course of the perforators. Perforators were safely located eccentrically when needed. Pedicle length and complications, such as infection, wound dehiscence, and partial or total flap loss, were recorded. Results Perforators were located eccentrically in 8 patients and centrally in the other 11 patients. Eleven flaps were used in lower leg reconstruction, 2 flaps in popliteal region, and 6 flaps in head and neck. All flaps survived and any partial or total loss did not occur. There was not any infection and wound problem. Conclusions Multidetector computed tomographic angiography can reveal the suprafascial course of the perforator and help design anterolateral thigh perforator flap. By using this kind of mapping, perforators can be safely located eccentrically to lengthen the pedicle and partial flap loss can be prevented.Item A painless, solitary, yellow-pink colored, vascularized, firm nodule on the foreheadArslan, Z; Çetinarslan, T; Bali, ZU; Evrenos, MK; Temiz, P; Ermertcan, ATItem Comparison of The Thickness of Free Anterolateral Thigh Flap in Different Fascial Planes: Clinical Results of Subfascial and Superficial Fat FlapTuluy, Y; Bali, ZU; Ünsal, MÖ; Parspanci, A; Yoleri, L; Çiçek, C; Filinte, GTBackground The anterolateral thigh (ALT) flap is a preferred option in the reconstruction of a wide variety of defects, enabling multiple tissue components and thicknesses.Methods This study was conducted to investigate the correlation of the thickness of the traditional subfascial ALT flap and superficial fat flap with age, gender, and body mass index (BMI). A total of 42 patients (28 males and 14 females) were included in the study.Results Mean age was 50.2 (range, 16-75) years and mean BMI was 24.68 +/- 4.02 (range, 16.5-34.7) kg/m(2) . The subfascial flap thickness was significantly thinner in male patients (16.07 +/- 2.77 mm) than in female patients (24.07 +/- 3.93 mm; p < 0.05), whereas no significant difference was found between male (4.28 +/- 1.15 mm) and female patients (4.85 +/- 1.09 mm) regarding superficial fat flap thickness ( p = 0.13). The thickness of both flaps had a positive correlation with BMI, and the strongest correlation was found for subfascial ALT thickness in female patients ( r = 0.81). Age had no effect on both flap thickness measurements. The anterior thigh is thicker in women than in men, although it varies according to BMI. This shows that flap elevation is important in the superthin plane, especially if a thin flap is desired in female patients in defect reconstruction with the ALT flap. Thus, a single-stage reconstruction is achieved without the need for a defatting procedure after subfascial dissection or a second defatting procedure 3 to 6 months later.Conclusion The appropriate ALT flap plane should be selected considering the gender and BMI of the patient.Item New Approach for Superthin Anterolateral Thigh Flap ElevationBali, ZU; Aksoy, A; Tuluy, Y; Parspanci, A; Keçeci, Y; Yoleri, LBackground: Anterolateral thigh (ALT) flaps are widely used for soft tissue reconstructions. They have several advantages, most notably a long pedicle, an appropriate pedicle caliber, low donor site morbidity, and the possibility of 2 teams working simultaneously. However, conventional, thick ALT flaps used for reconstructions of head and neck and lower extremity defects may cause postoperative range of motion limitations and cosmetic problems. The aim of this study was to develop and propose strategies to facilitate the harvest of superthin ALT flaps and minimize technical difficulties. This article provides step-by-step instructions for simple, quick, and reliable dissections of superthin ALT flaps. Methods: This study retrospectively analyzed data from 60 free superthin ALT flaps used for soft tissue reconstructions in 56 patients between January 2018 and February 2019. Superthin flaps were elevated just above the superficial Scarpa's fascia using a vertical approach. Results: Thirty-eight of the patients were operated on for lower extremity wounds, 16 were for head and neck defects, and 6 were for upper extremity wounds. The mean follow-up period was 7 months. The median hospital stay was 10 days. Total flap loss was observed in 4 cases (6.6%), and partial flap loss was observed in another 4 cases (6.6%). Conclusions: The superthin elevated ALT flap is a reliable and effective option for the reconstruction of soft tissue defects. In our vertical approach, the wide field of view of the flap perforator provides easy dissection, making it easier to elevate the superthin ALT flap.Item The evaluation of the effect of free gracilis muscle transfer on cheek tone and oral competence in long-standing facial paralysis of patients by using Blasco indexBali, ZU; Tuluy, Y; Ünsal, MÖ; Parspanci, A; Yoleri, L; Keçeci, YPurpose Smile and eyelid reanimation are generally emphasized in facial reanimation, but the loss of cheek tone provided by the buccinator muscle is not adequately addressed. The use of free gracilis muscle flap for facial reanimation has become widespread since it was used in head and neck reconstruction by Harii et al. The effect of free gracilis muscle transfer on drooling is not clearly defined in the literature. In our study, we aimed to evaluate the effect of free gracilis muscle transfer on drooling in patients with facial paralysis (FP) by using Blasco index. Smile function was overemphasized in the literature, but drooling was not evaluated. What happens to drooling after free functional muscle transfer was not clear, so this study was designed to evaluate improvement in drooling. Patients and Methods Drooling and smile were evaluated in 11 patients (4 male, 7 female) who underwent facial reanimation with a free functional gracilis muscle transfer (FFGMT), in long-standing FP. The mean age was 39.9 years (range 22-56 years). Etiology was idiopathic in two patients, trauma in five patients, and intracranial tumor in four patients. Photographs and video recordings were taken preoperatively and at the first year postoperatively. The muscle was stitched to the upper lip, corner of the mouth, lower lip and the preauricular region. Masseteric nerve was preferred as donor nerve. Smile restoration was evaluated according to the five-stage classification defined by Terzis and Noah. Results Flap dimensions differed from 12 cmx 5 cm to 15 cmx 6 cm. Oral intake was stopped for 5 days, and speaking was restricted postoperatively. Patients exercised for about 1 h starting from the postoperative third month. Patients were followed up for an average of 26.5 (14-48) months postoperatively. Postop courses were uneventful, and we did not observe any complications in these patients. Preoperative Blasco index score was 3 in 6 patients, 2 in 5 patients and the mean scores were 2.54 +/- 0.52. Patients were followed for 1 year. No drooling was observed in the postoperative first year. The Blasco index score was 0 for all patients. The decrease in postoperative scores was found to be statistically significant (p < .01). Smile restoration was evaluated according to the five-stage classification defined by Terzis and Noah for facial reanimation after muscle transfer. Excellent results (grade 5) were obtained in 6 patients, good results (grade 4) in 4 patients and moderate results (grade 3) in 1 patient. Conclusion Free functional gracilis muscle transfer improves chewing functions and prevents drooling. This case series reveals that FFGMT can be a good option to enable cheek tone in long-standing FP of patients.