Mini-temporalis transposition: a less invasive procedure of smile restoration for long-standing incomplete facial paralysis. 2015

Gang Chen, and Xianxian Yang, and Wei Wang, and Qingfeng Li
From the *Department of Plastic Surgery, Zhujiang Hospital, Southern Medical University, Guangdong, China; †Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Facial paralysis is a common craniofacial deformity that is responsible for significant psychological and functional impairment. Free muscle transfer in 2 stages and latissimus dorsi transfer in one stage may be the most effective surgical procedure for achieving a symmetrical spontaneous smile for a patient with complete facial paralysis. However, these 2 procedures are unsuitable for many incomplete patients. The authors introduce a less invasive procedure, termed mini-temporalis transposition that is able to achieve a symmetrical spontaneous smile in incomplete patients. Through a zigzag incision into the temporal region, the middle third of the temporalis is transferred and elongated with the palmaris longus tendon or combined with the deep temporal fascia. The strips are anchored to key points at the modiolus and the middle of the ipsilateral orbicularis oris muscle through a small intraoral incision and subcutaneous tunnel. The key points are marked during preoperative smile analysis. This procedure was applied to 15 patients with long-standing incomplete facial paralysis. All patients obtained improvements in smile symmetry after the operation, and patients' satisfaction was high. In addition, no damage to residual facial nerve functions or development of procedure-induced complications (such as a facial contour defect, lip eversion or puckering, or skin tethering) was observed in any of the patients. Nevertheless, slight temporal hollowing was observed in 4 patients, and mild bulkiness over the zygomatic arch was a common observation. In summary, the mini-temporalis transfer technique is a safe and effective method of smile restoration for long-standing incomplete facial paralysis.

UI MeSH Term Description Entries
D008297 Male Males
D004954 Esthetics The branch of philosophy dealing with the nature of the beautiful. It includes beauty, esthetic experience, esthetic judgment, esthetic aspects of medicine, etc. Aesthetics
D005149 Facial Expression Observable changes of expression in the face in response to emotional stimuli. Face Expression,Expression, Face,Expression, Facial,Face Expressions,Facial Expressions
D005152 Facial Muscles Muscles of facial expression or mimetic muscles that include the numerous muscles supplied by the facial nerve that are attached to and move the skin of the face. (From Stedman, 25th ed) Mimetic Muscles,Facial Muscle,Mimetic Muscle,Muscle, Facial,Muscle, Mimetic,Muscles, Facial,Muscles, Mimetic
D005158 Facial Paralysis Severe or complete loss of facial muscle motor function. This condition may result from central or peripheral lesions. Damage to CNS motor pathways from the cerebral cortex to the facial nuclei in the pons leads to facial weakness that generally spares the forehead muscles. FACIAL NERVE DISEASES generally results in generalized hemifacial weakness. NEUROMUSCULAR JUNCTION DISEASES and MUSCULAR DISEASES may also cause facial paralysis or paresis. Facial Palsy,Hemifacial Paralysis,Facial Palsy, Lower Motor Neuron,Facial Palsy, Upper Motor Neuron,Facial Paralysis, Central,Facial Paralysis, Peripheral,Facial Paresis,Lower Motor Neuron Facial Palsy,Upper Motor Neuron Facial Palsy,Central Facial Paralyses,Central Facial Paralysis,Facial Palsies,Facial Paralyses, Central,Facial Paralyses, Peripheral,Palsies, Facial,Palsy, Facial,Paralyses, Central Facial,Paralyses, Facial,Paralyses, Hemifacial,Paralysis, Central Facial,Paralysis, Facial,Paralysis, Hemifacial,Paralysis, Peripheral Facial,Pareses, Facial,Paresis, Facial,Peripheral Facial Paralysis
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective

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