Modification of the Orthodromic Temporalis Tendon Transfer Technique for Reanimation of the Paralyzed Face

Abstract

To report a modification of the temporalis tendon transfer technique used in facial paralysis where dynamic adjacent muscle transfer is determined to be the best treatment option. Case series with chart review. Tertiary care teaching hospital. Review of 10 consecutive patients who underwent orthodromic transfer of the temporalis tendon and the attached coronoid process for the treatment of longstanding facial paralysis. Outcomes measured included patient satisfaction, measurements of oral commissure elevation with smiling, and grading of preoperative and postoperative patient photographs by objective physician observers. Reporting of complications. Patient satisfaction was high, with a mean score of 7.0 (possible score of 10). Four patients were graded by the observer as excellent to superb. The other 6 patients were rated as having fair to good postoperative results. Movement was identified in every patient and ranged from 2.1 to 9.3 mm, with mean movement of the oral commissure of 5.12 mm. One patient developed a seroma at the site of harvest of the fascia that was drained without further complication. This facial reanimation procedure is a novel modification of the temporalis tendon transfer technique in which the coronoid process is transferred in conjunction with the tendon. This technique is minimally invasive and may result in less variability of the postoperative aesthetic result. The procedure allows orthodromic action of the temporalis muscle, is relatively easy to perform, and eliminates the facial asymmetry typically produced by transfer of the origin of the temporalis muscle.