Uses of the Superficial Temporal Fascial Flap in Facial Paralysis

Abstract

The superficial temporal fascia merits its popularity in reconstructive surgery for its large number of clinical applications. In this report, the authors present their experience with different uses of the superficial temporal fascial flap in facial reanimation. Seventeen cases are presented. In 10 patients, the fascial flap provided a vascularized lining at the interface between the free muscle flap for smile restoration and the overlying skin. In six cases, it was utilized to correct small or moderate contour deficits in the paretic hemiface, using either the fascial flap alone or in combination with free adipose tissue. One patient presented with facial paralysis and Frey syndrome following parotidectomy, and the fascial flap was used to control gustatory sweating. Five independent observers graded aesthetic and functional outcomes on a scale from poor to excellent. Three patients were lost to follow-up, so 14 cases were evaluated. Follow-up ranged from 1 to 216 months (47 +/- 60.49 months). The specific reconstructive goal for each patient was achieved and the overall symmetry was greatly improved, with all patients being granted higher scores by the panel of observers following the superficial fascia flap (Wilcoxon matched-pairs signed ranks, p < 0.0001). Transient or permanent alopecia along the temporal incision was the main complication observed. Transfer of the superficial temporal fascia flap is a valuable technique with several potential applications in facial paralysis management and reconstructive surgery in general. The advantages of this highly vascularized, gliding, and pliable flap far outweigh the associated minimal complications.