Temporalis pull-through vs fascia lata augmentation in facial reanimation for facial paralysis

Abstract

Objectives:Surgical rehabilitation of facial palsy is challenging as each case is unique and success rate is often unpredictable. In one technique, temporalis is elevated from origin preserving vessels, and this elevation increases the length which is tunneled into buccal tissues (pull-through technique, Group A). In the other technique, a harvested fascia lata is attached to temporalis after a coronoidectomy release and the fascia lata is attached to the modiolus (Group B). The aim of this study is to compare the two different surgical techniques.Materials and Methods:Case records of 22 cases, 15 females, and 7 males who were operated between 2008 and 2012 for facial palsy with at least 1-year follow-up, using either of the techniques were assessed for pull of muscle, postoperative pain, recovery time, motor control, and symmetry at rest. Descriptive statistics are presented.Results:The Group A (n = 7) and Group B (n = 15) formed the study group. In the Group A, residual asymmetry (n = 3), poor postoperative muscle pull (n = 2) were noticed while in the modified group it was 2 and 3, respectively. The technique used in Group B had better pull of muscle, symmetry, faster recovery time, and better motor control at 1-year follow-up than the conventional technique.Discussion and Conclusion:The difference between the two groups is due to preservation of original muscular architecture, vascular channel supply. As the muscle is not traumatized, no fibrosis occurs aiding regaining of normal function. In addition, the facial reanimation is more successful in the Group B. The mechanism and success behind the technique used in Group B is discussed elaborately in terms of localregional anatomy and physiology