Modified temporalis tendon transfer extended with periosteum for facial paralysis patients

Abstract

Background: We have devised a novel surgical method, termed as temporalis muscle tendonperiosteum (T-P) compound surgical method, by modifying pre-existing techniques. Our method is characterized by elevation of temporalis muscle tendon and the periosteum of the mandibular ramus as a single compound. Here, we describe the concept and clinical outcomes of our method. Methods: We conducted both a cadaveric study and a clinical study. First, we used four human cadavers (two males and two females) to confirm the anatomy of the temporalis muscle tendon and availability of sufficient length extension through the elevation of the T-P compound. Moreover, we obtained measurements of the mouth angle and the philtrum angle from a total of six patients (two males and four females) and compared them between preoperatively and postoperatively. Results: The mean length of the periosteal portion was measured as 2.43 ± 0.15 cm (range, 2.2-2.6 cm). There was an improvement in the mouth angle postoperatively as compared with preoperatively (7.2°± 3.0° vs. 14.5°± 4.7°, respectively). Moreover, there was also an improvement in the philtrum angle postoperatively as compared with preoperatively (7.2°± 3.4° vs. 17.2°± 6.5°, respectively). Conclusion: Our method is a simple, minimally-invasive modality that is effective in achieving good clinical outcomes. Its advantages include an ability to achieve a firm extension of the temporalis muscle tendon as well as a lack of requirement for a donor site that may cause complications.

Facial reanimation using the hypoglossal nerve and ansa cervicalis: a short-term retrospective analysis of surgical outcomes

“…Numerous strategies are used to manage facial palsy. Various surgical treatments have been utilized as dynamic procedures for facial paralysis [ 1 ], including cross-face nerve grafting; transfers of the hypoglossal nerve, masseter nerve [ 2 ], and ansa cervicalis [ 3 ]; temporalis muscle transfer [ 4 ]; and functional muscle transpositions. In 1903, Korte [ 5 ] introduced hypoglossal nerve transfer with end-to-end coaptation, which has been considered as the traditional method.…”

Proposal for a modified classification of isolated zygomatic arch fractures

“…Therefore, bone displacement and the force vector of the injury are the most important factors to consider when classifying isolated zygomatic arch fractures. Two important masticatory muscles (the temporalis and masseter muscles) are related to the zygomatic arch [ 13 ]. When the zygomatic arch fractures, direct bone-to-bone contact with the coronoid process of the mandible may result depending on the fracture position, resulting in sudden coronoid impingement.…”

Facial palsy reconstruction

“…In this technique, proximal muscles are employed for dynamic reconstruction. The temporalis, masseter, and digastric muscles are connected to the corners of the mouth to form a voluntary smile [24]. Traditionally, the approach involves dissecting the upper insertion of the temporal muscle, transposing it in the reverse direction (orthodromic), and securing it to the modiolus [25][26][27].…”