<p><strong>Objective: </strong>To address objective excursion and symmetry results from a series of free gracilis muscle transfer (FGMT) cases and examine the predictive intraoperative number of vectors anchored during flap inset on outcomes.</p>
<p><strong>Method: </strong>A retrospective analysis was performed by data retrieved from the HUSM Plastic &amp; Reconstructive Surgery OR Registry from January 2005 to June 2019. All patients who reported facial nerve palsy were recorded and re-evaluated. All characteristics in interest were epidemiologically tabulated and analyzed in detail. Subsequently, outcome assessment was performed to look for facial symmetry and smile excursion with comparison to the healthy side of the face.</p>
<p><strong>Results</strong>: Out of 12 patients diagnosed with facial palsy, 4 patients underwent static facial reanimation and 8 patients underwent dynamic facial reanimation with 4 of them completed 2 stages of cross facial nerve grafting (CFNG) and free gracilis muscle transfer (FGMT). One of the FGMTs had missed a follow-up. The mean age was 20 (range 11 to 30), 1 patient was male and 2 were female. The mean duration for follow up was 69 months. The mean duration of operating time was 8.67 hours. All operations without complication and there was no microvascular re-exploration. Smile excursion and angle excursion at smile improved following FGMT. Association between the number of vectors anchored during flap inset to the outcome were identified.</p>
<p><strong>Conclusions</strong>: Dynamic facial reanimation using FGMT still the gold standard of treatment which provides a good quantifiable improvement in oral commissure excursion and facial symmetry with smiling.&nbsp; Use of multivector gracilis flap was suggestive to associate with the good outcome on an excursion and symmetrical of the smile.</p>