Temporalis Myoplasty Research Articles

Cerebral Plasticity after Lengthening Temporalis Myoplasty in Facial Palsy: A Magnetoencephalography Study.

Cerebral Plasticity after Lengthening Temporalis Myoplasty in Facial Palsy: A Magnetoencephalography Study.

Dynamic Reconstruction Using Bilateral Lengthening Temporalis Myoplasty for Facial Palsies in Patients with Hereditary Skin Laxity.

Hereditary skin laxity is a rare condition, some cases of which are also referred to as cutis laxa, and those involving facial skin are considered a target for treatment by plastic surgery as patients present with an aged face, which can reduce their quality of life. In some of these patients, the facial nerve and muscles may be affected, and cause weakness of mimetic muscles. We performed one-stage bilateral lengthening temporalis myoplasty reanimation, followed by lower facial contouring with partial lower lip excision and hammock-shaped fascia grafting in two patients with hereditary facial skin laxity coexisting with facial palsy. The patient was a 63-year-old woman with hereditary gelsolin amyloidosis and a 64-year-old man who was diagnosed with oculopharyngeal muscular dystrophy. Postoperatively, a symmetrical facial contour was achieved in repose, and smiling with and without biting was possible. To our knowledge, there are no reports of dynamic smile reconstruction for facial weakness in patients with hereditary facial skin laxity. Although these patients may experience progressive loss of function of the trigeminal nerve and its innervating muscles, the static suspension effect of lengthening temporalis myoplasty can be expected to continue even if the temporal muscles lose their function in the future. We believe that, with careful patient selection, dynamic reconstruction is an option for progressive facial paralysis. In this article, we present the chronological history of two patients who underwent multiple plastic surgery procedures and discuss the importance of the role of plastic surgery in improving the quality of life under these conditions.

Midface microvascular reconstruction after maxillary complex tumor resection: A retrospective study

The study purpose is to review the surgical approach and evaluate the results in managing patients with advanced midface and maxillary complex tumors.The most common anatomical site of the primary tumor was the maxilla, sometimes with extension to the orbit and anterior fossa, parotid and middle ear or even the lip. Surgical resection included maxillectomy in the majority of cases, combined with orbital exenteration or orbitectomy and anterior fossa resection. Parotidectomy and mastoidectomy/core petrosectomy were also performed. Reconstruction was performed with radial forearm osteocutaneous free flap, latissimus dorsi myocutaneous flap with scapular bone flap, lengthening temporalis myoplasty, rectus abdominis free flap, anterolateral thigh flap, in combination with temporalis and vastus lateralis, as well as pectoralis major myocutaneous flap.A total of 36 midface tumor excisions were performed, followed by the appropriate reconstruction. The average follow-up period was 15 years. To date, 23 patients are disease free, while 6 patients presented disease recurrence and 7 patients died during the 15-year follow-up period.Surgical resection remains the gold standard for midface tumors management. When safely performed, combined with microvascular and dynamic face reconstruction, surgery can offer improvement in quality of life and prolong the overall survival.

Public and patients’ perceptions of facial reanimation using lengthening temporalis myoplasty

To answer the clinical research questions: "Among facial paralysis patients (FPPs), did lengthening temporalis myoplasty (LTM) improve public's perceptions, patients' perceptions, as well as objective oral measurements of post-operative outcomes?" To answer the research questions, we designed and implemented a hybrid cross-sectional and retrospective cohort study enrolling a cohort of laypersons and FPPs treated at a tertiary care center from 2011 to 2020. The primary predictor variables were LTM in FPPs (before/after) and medical background on medical care (FPPs/laypersons). The main outcome variable was post-operative outcomes (from a public's perspective, FPPs' perspective, and with objective measurements). Descriptive and univariate statistics were computed as appropriate, and P ≤ 0.05 was considered statistically significant. The sample consisted of 203 lay volunteers and 15 FPPs. After LTM, public perception voted the significant improvements in disfigured, important to repair, bothersome, severity (DIBS) score, and facial attractiveness. Patients' perspective was also significantly improved for global severity, oral function, and facial movement. Objective measurements of deviation at the oral commissure and the smile angle also significantly improved after LTM. Despite no control groups (i.e., other techniques to be compared) in this study, our study results suggest that LTM can be used to improve public's perception, patient's perception, and objective oral measurement of post-operative outcomes in FPPs. Because different questionnaires were used, it is unknown whether public and patient's perceptions are compatible.

Stabilisation et réanimation de la lèvre inférieure paralysée. Étude rétrospective de 66 cas et revue de la littérature. Proposition d’un algorithme décisionnel

Several techniques for the stabilization and the reanimation of the paralyzed lower lip have been proposed, sometimes combined but the authors are rather vague. Thanks to our cases and a literature review, we suggest an algorithm. Sixty-six patients haven been reviewed. The static and dynamic clinical evaluation have been done thanks to the study of the medical files, photographs and videos samples. The different techniques we have used were: (a) botulinum toxin in the contralateral depressor labii inferioris (DLI) (n=66), contralateral DLI myectomy (n=1); (b) a strip of fascia lata (n=16) either combined with a lengthening temporalis myoplasty (MAT) (n=10) or only realizing a passive suspension thanks to one vector (n=4), or a passive suspension with two strips (n=2); (c) digastric muscle transfer (n=4). When the elevator muscles are sounds, botulin toxin (± myectomy) is proposed if the lower lip is not inverted. Otherwise, a suspension thanks to a digastric muscle transfer or a passive suspension with a horizontal and a vertical strips are recommended. If the elevator muscles are no more operational, a MAT with a passive suspension with one vector is considerated and if the lower lip is inverted, a digastric muscle transfer with a fascia lata strip or a MAT with two strips is proposed. This algorithm submission allows to refine the treatment of the stabilization and the reanimation of the lower lip.

Modified Lengthening Temporalis Myoplasty Using an Intraoral Approach.

Lengthening temporalis myoplasty (LTM) is a unique and definite facial reanimation procedure that involves inserting the whole temporal tendon directly into the nasolabial fold. However, the nasolabial fold incision remains one of the difficulties of this procedure, particularly in young or female patient. To avoid the need for this incision, the authors developed an intraoral approach to manipulate the temporal muscle tendon toward the nasolabial fold. in this study, we describe the details of this procedure. The authors performed their intraoral approach procedure in 5 patients with established complete facial paralysis. instead of making an incision at the nasolabial fold to approach the coronoid process, the authors made the incision at the buccal mucosa. The results were evaluated both subjectively and objectively. The authors achieved facial reanimation without leaving any obvious scar on the face or neck and the effect of static reconstruction is obvious, even immediately after the surgery. All the patients obtained good facial movement within 4 months (2.5 months in average), and improved all evaluated parameters postoperatively. No infections or other major complications were reported following surgery; however, 1 patient developed a slight dimple that required revision. The authors could advance temporal tendon toward nasolabial fold firmly obtaining sufficient surgical field similar to that of nasolabial fold incision, and achieved fairly good results without an obvious scar on the face.Establishing LTM without nasolabial fold incision, we could expand the indication of LTM more widely, and it could be more familiar procedure for smile reanimation in all generation.

The pedicled masseter transfer for facial nerve palsy reconstruction—an anatomical study

Dynamic facial reanimation is one of the key treatment goals for lower facial palsy patients. Currently, temporalis myoplasty is the only non-free flap muscle transfer option considered feasible with good outcome. Although masseter transfer has been attempted, it was associated with poor results or considered to be technically challenging. This cadaveric study aimed to re-evaluate the feasibility of masseter transfer by looking at its geometry and offer a new approach to the muscle. Twenty-four masseter muscles were dissected in 12 fresh frozen cadavers through a preauricular rhytidectomy incision and a pre-parotid approach. The muscle’s insertion and origin attachments were divided to allow for rotation toward the modiolus. The angle of rotation, vector of pull, transfer distance, and length of the muscle were measured. The mean angle of rotation was 40.1 degrees, and the mean vector of pull was 66.7 degrees. The mean transfer distance from the muscle’s origin and insertion attachments was 30 and 62.5 mm, respectively. The mean lengths of the muscle’s anterior, posterior, superior, and inferior borders were 55.3 mm, 46.3 mm, 42.6 mm, and 42 mm, respectively. The distance, angle of transposition, and vector of pull measurements support the feasibility of pedicled masseter transfer in achieving optimal contraction vector with less risk of pedicle injury in lower facial palsy reconstruction. Tendon and fascial grafts can be adjuncts in cases where the masseter muscle length is short. The pre-parotid approach to the pedicled masseter transfer allows for a shorter operative time, which is desirable, particularly in the infirm. Level of evidence: Not ratable .

Suprazygomatic Aponeurotic McLaughlin Myoplasty for Facial Reanimation.

Suprazygomatic aponeurotic McLaughlin (SAM) myoplasty technique for facial reanimation is based on the classical McLauglin's lengthening temporalis myoplasty with a series of new modifications. A comprehensive review of previously described other orthodromic temporalis myoplasty techniques is also included to give a succinct comparison. Twelve adult patients of facial palsy underwent SAM myoplasty for a period of 4 years. Three had congenital facial palsy, 4 patients had facial palsy secondary to acoustic neuromas, 3 were posttraumatic, and 2 patients had Bell's palsy. Range of modiolus excursion achieved as measured at 3 months postoperatively on reanimation in our patients was 5 mm to 20 mm with an average of 12.6 mm. With SAM myoplasty technique, we were able to achieve excellent result in 4 patients and good results in 8 patients as evaluated with May and Druker scoring system. Suprazygomatic aponeurotic McLaughlin myoplasty for facial reanimation demonstrates a successful modification of the classical McLaughlin lengthening temporalis myoplasty, making it more customizable, simple, and predictable by taking the level of transection to the temporalis aponeurosis without the need for zygomatic osteotomy. A new classification of orthodromic temporalis myoplasty based on level of transections is also proposed for the first time. Good to excellent outcomes coupled with high patient satisfaction and low morbidity should make this technique popular among the facial reanimation surgeons.

Temporalis Tendon Transfer/Lengthening Temporalis Myoplasty for Midfacial Static and Dynamic Reanimation After Head and Neck Oncologic Surgery.

Importance: Facial nerve paralysis is an unfortunate, yet relatively common sequela in the treatment of head and neck cancer. Static options for reanimation of the paralyzed midface and oral commissure offer limited quality-of-life improvement and may stretch over time. Reinnervation offers a prolonged recovery and may not be possible among patients with advanced cancer or in salvage situations. Objective: To determine the improvement in resting tone and dynamic excursion gained by use of temporalis tendon transfer (TTT) and lengthening temporalis myoplasty (LTM) for facial nerve reanimation among patients undergoing oncologic head and neck cancer surgery. Design, Setting, and Participants: We present the largest series of primary and secondary TTT operations with prolonged photographic and video-based data with analysis enabled by FaceGram open-source quantitative methodology. This was achieved using preoperative and postoperative digital photographs of each patient at rest and full smile excursion. Using the JAVA-based program Facegram v1.0, measurements were taken of the oral commissure in relation to a line tangent to the inferior border of the lower lip. All operations were performed at the University of California, San Francisco, following oncologic resections between April 2011 and June 2018. Main Outcomes and Measures: Quantitative analysis of facial measurement with Facegram. Results: Of the 32 patients in our series, 19 (59.4%) were male and 13 (40.6%) were female. The average age was 71.3 ± 10 years. There was a mean 4.89 mm (p < 0.01, 95% confidence interval [CI]: 2.78-6.99) increase in height of affected side oral commissure compared with preoperative measurements during full smile excursion, and a 3.05 mm (p < 0.04, 95% CI: 0.22-5.87) increase in horizontal excursion of smile vector. There was also a significant increase in static support at rest, measuring an average of 5.45 mm (p < 0.01, 95% CI: 2.56-8.33) and 2.71 mm (p < 0.04, 95% CI: 0.18-5.25) increase in affected oral commissure vertical and horizontal positions at rest, respectively. The average postoperative follow-up was 11.4 months (95% CI: 5.6-14.11). In addition, when compared with patients treated with postoperative radiation therapy (9 patients), those who received preoperative radiation (15 patients) had a significant improvement in the resting vertical height of the affected side (mean 5.32 mm (p < 0.05, 95% CI: 0.06-10.57)). Conclusions and Relevance: These findings encourage the use of TTT/LTM for facial nerve paralysis in appropriately selected head and neck oncologic patients.

Dynamic smile reanimation in facial nerve palsy.

ObjectivesLong-term facial paralysis results in degeneration of the distal nerve segment and atrophy of the supplied muscles. Options for these patients include free muscle transfer, temporalis myoplasty, and botulinum toxin injections for smile reanimation. In this study we aimed to evaluate the subjective and objective outcomes of these procedures.Materials and MethodsIn our study, we retrospectively analyzed smile symmetry in patients with facial palsy (n=8) who underwent facial reanimation procedures.ResultsSubjective analysis showed high satisfaction in seven out of eight patients. Objective analysis showed statistically significant improvement postoperatively in both vertical and horizontal smile symmetry at rest and during maximum smile (P<0.001).ConclusionChoosing the ideal procedure for the patients is the most critical aspect for facial reanimation. Though free muscle transfer is considered gold standard procedure, temporalis myoplasty also gives satisfactory results. Residual synkinesis which can lead to disturbing aesthetic deformity can be effectively treated with botulinum toxin.

Intraoral temporalis transposition for facial reanimation: A novel technique in facial nerve palsy

BackgroundFacial palsy patients require reconstructive surgery because they suffer from an expressionless and deformed appearance especially during smiling. To gain a natural smile, various dynamic procedures rather than static procedures are performed. Through cadaveric studies with clinical implications on temporalis muscle and intraoral transposition, we were able to come up with a more effective and less invasive procedure than the conventional temporalis muscle transposition or lengthening temporalis myoplasty. The aim of this study is to describe our novel surgical technique for facial reanimation and evaluate its efficacy. MethodTwo intraoral incisions were made. Through the posterior incision, the tendinous portion of the temporalis was separated from the coronoid process and anterior border of the ramus. Through the anterior incision, submucosa tunneling was performed to fixate the temporalis tendon onto the new perioral site. Results14 patients with facial palsy underwent intraoral temporalis transposition and their mouth corner excursion was measured for objective assessment after surgery. At resting state, mouth and cheek drooping was improved. At smiling, the excursion of the unaffected side was 10–17 mm. For the reconstructed side, 8 cases were considered excellent (exceeding 75% of normal side), 5 cases were considered good (exceeding 50%), and 1 case fair (exceeding 25%). ConclusionThis temporalis transposition through the intraoral approach is a novel technique for facial reanimation reconstruction. It is s less invasive, immediately effective method with rapid recovery and minimal donor site morbidity without visible scar. Level of evidenceIV.

The temporalis muscle and its relationship to the accessory attachments and the main pedicle—a cadaveric study

Lengthening temporalis myoplasty, described by Daniel Labbe in 1997, is a facial reanimation procedure for the treatment of facial nerve palsy. It involves the mobilization of temporalis muscle antero-inferiorly, and the insertion of its tendon at the nasolabial fold-oral commissure region. Knowledge of the temporalis muscle is crucial in performing this procedure; however, previous anatomical studies are limited. This study on cadavers, aimed to describe the anatomical location of the temporalis muscle insertion in relation to the adjacent structures, and its main pedicle to aid surgeons in performing this procedure. Twenty-four temporalis muscles were dissected in 12 fresh frozen cadavers. The anatomical location of the temporalis muscle insertion, accessory attachments, the emergence of the posterior deep temporal artery, and the distance of sliding movements from the coronoid process to the nasolabial fold were recorded. In addition to its origin from the temporalis fossa and its insertion at the coronoid process, the temporalis muscle was found to have multiple accessory attachments to adjacent structures. These findings explain the challenges in performing the sliding action without releasing the accessory attachments to the masseter and pterygoid muscles. The deep posterior temporal artery is located inferoposteriorly in relation to the muscle. Therefore, the muscle elevation maneuver performed without direct vision can be done with minimal risk to the muscle pedicle. The knowledge of temporalis muscle insertion, its accessory attachments, and its main pedicle will facilitate surgeons in performing the lengthening temporalis myoplasty more confidently.

S8B-04 SESSION 8B: FACE RESEARCH - PART I ANALYSIS OF DIFFERENTIAL EXCURSION OF THE TEMPORALIS MUSCLE AND TENDON INSERTION ON THE CORONOID PROCESS: IMPLICATIONS IN LABBE PROCEDURE

Introduction: Lengthening Temporalis Myoplasty (Labbe procedure) is a one-stage procedure performed for reanimation of the middle third of the face with the ultimate purpose of creating a natural smile. The Temporalis muscle is a broad muscle with multiple tendon slips that coalesce into a single tendon which inserts on the coronoid process. During Labbe procedure, the muscle is detached from its origin and advanced anteriorly and inferiorly to allow reattaching the temporalis muscle tendon to the oral commissure. We hypothesized that the tendinous insertion pattern of anterior and posterior halves of the muscles has implications on the differential excursion of the muscle. Methods: The anatomy and patterns of tendon insertion of four temporalis muscles in 2 fresh cadavers were analyzed. Results: In all dissected specimens, the temporalis muscle tendon inserted on the apex, convex anterior border, concave posterior border, lateral surface, and medial surface of the coronoid process. Posteriorly, the insertion extended to the midpoint of the sigmoid notch (mean of 1.2 cm from the apex of the coronoid process). Anteriorly, the insertion extended onto the anterior border of the ramus (mean of 1.5 cm from the apex of the coronoid process). Laterally, the insertion extended inferiorly to cover a mean surface of 1.8 cm from the apex of the coronoid process. Medially, the anterior half of the tendon inserted on a mean surface of 2 cm while the posterior half inserted on a mean surface of 5 mm from the apex of the coronoid process. The posterior half of the muscle inserted (via the posterior half of the tendon) to the posterior border of the coronoid process, anterior half of the sigmoid notch, and the most superior 5 mm of the medial surface while the anterior half of the muscle inserted (via the anterior half of the tendon) onto the apex, anterior border of the coronoid process, the most superior 1.5 cm of the anterior border of the ramus, and the most superior 2 cm of the medial surface. When traction was individually applied to the posterior and anterior halves, the excursion appeared confined to the respective half of the tendon inserting the muscle part subject to traction. Conclusion: In Labbe procedure, the posterior half of the muscle is placed under optimal tension and it is the part that provides the majority of the excursion. Inclusion of the posterior half of the temporalis tendon when suturing the tendon to the oral commissure is crucial to ensure optimal excursion of the temporalis muscle during Labbe procedure. Knowing the topography and pattern of tendon insertion permits achieving this goal.

Lengthening temporalis myoplasty and reduction of the swallowing oral phase dysfunction in facial palsy patients

IntroductionFacial palsy can cause dysfunction in the oral phase of swallowing. Lengthening temporalis myoplasty is a widely used technique for correction of facial asymmetry in facial palsy. The aim of this study was to determine whether lengthening temporalis myoplasty could reduce the dysfunction in the oral phase of swallowing in patients with facial palsy. Materials and MethodsThis prospective study enrolled 13 patients undergoing lengthening temporalis myoplasty. Lip continence, bolus residue, and perceived disability before surgery and at 3 months and 6 months after surgery were compared. Lip force was evaluated with a manometric test and drooling with a self-administered questionnaire. Bolus residue was assessed visually. Perceived disability was evaluated using a self-administered questionnaire. ResultsLip force improved significantly (from 58.23 ± 23.35 mmHg to 91.15 ± 18.36 mmHg; p = 0.001). Drooling showed a corresponding reduction, with the score decreasing from 4.31 ± 1.8 to 3 ± 1.41; p = 0.025. A decrease in bolus residue was also noted; the score decreased from 1.39 ± 0.77 to 0.46 ± 0.66; p < 0.001. These changes contributed to a significant reduction in perceived physical disability; the score decreased from 6.15 ± 3.74 to 3.46 ± 5.70; p = 0.004). ConclusionLengthening temporalis myoplasty, in addition to providing smile reanimation, may also reduce the dysfunction of the oral phase of swallowing in patients with facial palsy.

Facial Reanimation in the Seventh and Eighth Decades of Life.

Treatment of facial paralysis in the older population is often relegated to static rather than dynamic reanimation for fear of poor outcomes. This pervasive approach lacks physiologic foundation and is not evidence based. Thus, the authors present an extensive literature review demonstrating weak evidence supporting this misguided concept, followed by detailed outcomes from three centers of the largest reported series to date of patients older than 60 years after reanimation performed using three techniques-lengthening temporalis myoplasty, free functional muscle, and nerve transfers. A PubMed search spanning over 40 years identified all reports on reanimation in patients older than 60 years. In addition, detailed demographics, surgical techniques, and outcomes of 30 patients older than 60 years were analyzed. Of 629 articles, only 45 patients were identified, described in case reports or small series, lacking details or consistent long-term follow-up. In the clinical series, average age, preoperative House-Brackmann score, and comorbidities were similar among the groups. Highest excursion was observed in the free functional muscle group, followed by nerve transfer and temporalis myoplasty, averaging 10.4, 6.8, and 3.1 mm, respectively. The most notable philtral deviation correction was in the lengthening temporalis myoplasty group, followed by the free muscle and nerve transfer groups, averaging 5.6, 2.2, and 1.13 mm, respectively. Complication rates were highest in the free functional muscle group. Facial palsy patients should not be denied dynamic restoration based on age alone. Although surgical technique may vary based on duration of palsy, surgeon experience, and preference, with each presenting advantages and disadvantages, dynamic restoration is feasible regardless of age. Therapeutic, IV.

Modified Lengthening Temporalis Myoplasty Involving an Extended Lazy-S Incision to Avoid Facial Scar Formation.

Lengthening temporalis myoplasty is a faster and less invasive alternative to free muscle transfer for smile reconstruction. However, it requires a nasolabial fold incision, which leaves a midfacial scar. Based on esthetic considerations, a modified approach, involving an extended lazy-S (parotidectomy) incision instead of a nasolabial fold incision, was developed. A cadaveric study involving 10 hemifaces was conducted. From February 2013 to March 2016, the modified lengthening temporalis myoplasty procedure was employed in 10 patients. The results were graded from 1 (poor) to 5 (excellent) according to the Terzis grading system. The excursion of the oral commissure was also measured. The extended lazy-S incision provides easy and safe access to the coronoid process and good visibility. The patients' mean age was 56.5 years, and the mean duration of the postoperative follow-up period was 22.2 months. The patients' underlying conditions included acoustic neuroma (n = 2), Bell palsy (n = 3), congenital conditions (n = 2), brain infarction (n = 1), Ramsay Hunt syndrome (n = 1), and malignant parotid lymphoma (n = 1). One patient suffered a surgical site infection, which was successfully treated with irrigation. All the patients achieved improvements in smile symmetry: 2, 5, and 3 patients obtained excellent, good, and moderate results, respectively. The excursion of the oral commissure ranged from 5 to 10 mm. The modified lengthening temporalis myoplasty procedure provides satisfactory functional outcomes without causing significant complications. It does not leave a facial scar and is a preferable option, especially for young and female patients, and patients who have undergone ablative surgery involving the parotid region.

Lengthening Temporalis Myoplasty vs Free Gracilis Muscle Transfer with Cross Face Nerve Graft for Long-Standing Facial Paralysis in Children: An Objective Measure of Outcomes Using Oral Commissure Excursion

Lengthening Temporalis Myoplasty vs Free Gracilis Muscle Transfer with Cross Face Nerve Graft for Long-Standing Facial Paralysis in Children: An Objective Measure of Outcomes Using Oral Commissure Excursion

Lengthening Temporalis Myoplasty: Objective Outcomes and Site-Specific Quality-of-Life Assessment.

Objective Evaluate outcomes of the lengthening temporalis myoplasty in facial reanimations. Study Design Case series with planned data collection. Setting Ospedali Riuniti, Bergamo, and AOUC Careggi, Florence, Italy. Subjects and Methods From 2011 to 2016, 11 patients underwent lengthening temporalis myoplasty; demographic data were collected for each. Pre- and postoperative photographs and videos were recorded and used to measure the smile angle and the excursion of the oral commissure, according to the SMILE system (Scaled Measurements of Improvement in Lip Excursion). All patients were tested with the Facial Disability Index, and they also completed a questionnaire about the adherence to physiotherapy indications. Results All patients demonstrated a significant improvement in functional parameters and in quality of life. On the reanimated side, the mean z-line and a-value, measured when smiling, significantly improved in all patients: from 22.6 mm (95% CI, 20.23-25.05) before surgery to 30.9 mm (95% CI, 27.82-33.99) after surgery ( P < .001) and from 100.5° (95% CI, 93.96°-107.13°) to 111.6° (95% CI, 105.63°-117.64°; P < .001), respectively. The mean postoperative dynamic gain, passing from rest to a full smile at the reanimated side, was 3.1 mm (95% CI, 1.30-4.88) for the z-line and 3.3° (95% CI, 1.26°-5.29°) for the a-value. The Facial Disability Index score increased from a preoperative mean of 33.4 points (95% CI, 28.25-38.66) to 49.9 points (95% CI, 47.21-52.60) postoperatively ( P < .001). Conclusions The lengthening temporalis myoplasty can be successfully used for smile reanimation, with satisfying functional and quality-of-life outcomes.

Paralysie faciale chez l’enfant

Facial palsy (FP) in children is congenital or acquired. When present at birth (congenital), etiologies are mostly traumatic and rarely developmental. Acquired FP needs investigation. Research on the etiology helps to determine prognostic and treatment. At most times, no specific cause is found. Treatment of idiopathic FP consists of early oral corticosteroid therapy and ocular protection. Treating the sequelae is essential and the physician has to consider the dynamic balance of both sides of the face. Dynamic rehabilitation should mainly concern the inferior facial third. We recommend the lengthening temporalis myoplasty (LTM). This relevant technique ensures replicable and reliable results with a harmonious smile. Facial dynamic rehabilitation after surgical procedure (muscle tranfer or free muscle flap) must be directed toward control of voluntary movement, to move from a mandibular smile to a spontaneous and voluntary smile, thanks to brain plasticity. Furthermore, botulinum toxin is well tolerated and remains a great tool to treat a child who can support injections.

Lengthening Temporalis Myoplasty: Virtual Animation-Assisted Technical Video.

Lengthening temporalis myoplasty is a well-established procedure for dynamic palliative reanimation of the lip in facial palsy sequelae. The particularity of this technique is that the entire temporal muscle is transferred from the coronoid process to the upper half of the lip without interposition of aponeurotic tissue. To date, no video describing the technique was available. This is the first video describing the entire procedure, from preoperative markings through postoperative rehabilitation. In the video presented herein, the authors craft virtual three-dimensional animations in addition to a live operation on a patient performed by Daniel Labbé, who first described this technique 20 years ago.