Intraoperative muscle electrical stimulation for accurate positioning of the temporalis muscle tendon during dynamic, one-stage lengthening temporalis myoplasty for facial and lip reanimation.
BACKGROUND
Facial paralysis is a significant functional and aesthetic handicap. Facial reanimation is performed either by two-stage microsurgical methods or by regional one-stage muscle pedicle flaps. Labbé has modified and improved the regional muscle pedicle transfer flaps for facial reanimation (i.e., the lengthening temporalis myoplasty procedure). This true myoplasty technique is capable of producing a coordinated, spontaneous, and symmetrical smile. An intraoperative electrical stimulation of the temporal muscle is proposed to simulate the smile of the paralyzed side on the surgical table.


METHODS
The intraoperative electrical stimulation of the temporalis muscle, employing direct percutaneous electrode needles or transcutaneous electrical stimulation electrodes, was utilized in 11 primary and four secondary cases with complete facial palsy. The duration of the facial paralysis was up to 12 years. Postoperative follow-up ranged from 3 to 12 months.


RESULTS
The insertion points of the temporalis muscle tendon to the nasolabial fold, upper lip, and oral commissure had been changed according to the intraoperative muscle stimulation in six patients of the 11 primary cases (55 percent) and in all four secondary (revisional) cases. A coordinated, spontaneous, and symmetrical smile was achieved in all patients by 3 months after surgery by employing speech therapy and biofeedback.


CONCLUSIONS
This adjunct intraoperative refinement provides crucial feedback for the surgeon in both primary and secondary facial palsy cases regarding the vector of action of the temporalis muscle and the accuracy of the anchoring points of its tendon, thus enhancing a more coordinated and symmetrical smile.
Har-Shai
Yaron
Y
Haifa, Israel; and Caen, France From the Departments of Plastic Surgery, Carmel and Linn Medical Centers, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology; and the Department of Plastic Surgery, Caen Univesity Hospital.
Gil
Tamir
T
Metanes
Issa
I
Labbé
Daniel
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004558:Electric Stimulation / Q000379:methods*; D005158:Facial Paralysis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D013703:Temporal Muscle / Q000294:innervation / Q000503:physiopathology / Q000637:transplantation*; D013709:Tendon Transfer / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult