Mini-Temporalis Transfer as an Adjunct Procedure for Smile Restoration

Abstract

The versatility of the temporalis muscle justifies its wide popularity in reconstructive craniomaxillofacial surgery. In late facial paralysis, results of neural reconstructive techniques such as cross-facial grafting or mini-hypoglossal-to-facial nerve transfer are partial at best. In this series, the authors have used a segmental temporalis transfer, the "mini-temporalis," to augment the function attained with neural microsurgery. The aim of this present study was to present the experience of the authors' center with the use of the mini-temporalis as an adjuvant to facial nerve microsurgery for smile restoration. Data were collected from 31 patients who underwent mini-temporalis transfer for smile restoration. In all patients, the mini-temporalis was used to augment the results of neural reconstructive techniques. Opting for the mini-temporalis related to a variety of reasons, after preoperative evaluation was weighed against the advantages and disadvantages of different reconstructive strategies on individual bases. Aesthetic and functional outcomes were evaluated by a panel of five independent observers using a five-category scale ranging from poor to excellent. All patients observed a follow-up longer than 3 months. Of 31 patients, 61.3 percent achieved excellent or good results and 29 percent achieved moderate results. All patients demonstrated an increase in the observers' scores after mini-temporalis transfer in comparison with the scores granted preoperatively or after neural microsurgery. Highly motivated patients committed to postoperative motor reeducation exhibited the best results. The clinical data presented support the use of mini-temporalis transposition in association with facial nerve microsurgery as a valuable alternative to free muscle transfer in selected cases.