Use of mini-temporalis transposition to improve free muscle outcomes for smile.
BACKGROUND
In managing late facial paralysis, association of cross-facial nerve grafting and free muscle transfer proves superior to any other method of mid-face reanimation. Nevertheless, predicting functional recovery remains a struggle, and in a minority of patients, results are deceiving. In this study, cases of fair or moderate outcomes from a free muscle transfer received a segmental temporalis transposition to upgrade the functional and aesthetic results.


METHODS
From 1981 to 2007, 153 patients received a free muscle transfer for smile restoration in the authors' center. Of all patients, 72 percent (110 patients) required a third stage of revisions. In 41 cases, mini-temporalis transfer was used to augment moderate outcomes of a free muscle transfer. The exclusion criterion was less than 3 months' follow-up; thus, six patients were not evaluated. Each patient was videotaped at three successive time points (preoperatively, following free muscle transfer, and following mini-temporalis transfer). Five independent observers graded patients' videos using a five-category scale from poor to excellent.


RESULTS
In all of the patients, the averaged scores were higher after free muscle transfer in comparison with the preoperative scores (Wilcoxon signed rank test, p < 0.0001). After mini-temporalis transfer, 97.1 percent of the patients had scores that were increased further and 2.8 percent had the same scores. Alopecia along the coronal incision was seen in four patients, and hollowing of the infratemporal fossa was seen in five.


CONCLUSIONS
Analysis of these clinical data supports the use of mini-temporalis transfer as a safe and reliable method of correcting imperfect outcomes following a free muscle transfer for smile restoration.
Terzis
Julia K
JK
Norfolk, Va. From the International Institute of Reconstructive Microsurgery, Microsurgery Program, Eastern Virginia Medical School, Department of Surgery, Division of Plastic and Reconstructive Surgery.
Olivares
Fatima S
FS
D000293:Adolescent; D000328:Adult; D002648:Child; D005154:Facial Nerve / Q000502:physiology / Q000601:surgery*; D005158:Facial Paralysis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012904:Smiling / Q000502:physiology*; D013524:Surgical Flaps; D013703:Temporal Muscle / Q000294:innervation / Q000502:physiology / Q000601:surgery*; D055815:Young Adult