Technique Helps to Reanimate Paralyzed Faces

Patrick J. Byrne, M.D., and colleagues at The Johns Hopkins University School of Medicine, Baltimore, report the results of seven facial paralysis patients treated with temporalis tendon transfer. This technique typically involves an incision beginning at the ear and ending 3 to 4 centimetres into the hairline at the temple.

The temporalis muscle, a fan-shaped muscle on the side of the head, is cut at the point that it connects to the jawbone and released from the tissue surrounding it. Then, it is stretched to the point where the muscles of the mouth join together. The tendon that previously connected the temporalis muscle to the jawbone is cut free and then stretched horizontally for 3 to 4 centimetres; it is sutured to the surrounding muscles and deep skin tissue. Physical therapy to retrain facial muscles begins before the surgery and continues beginning seven days after the procedure.

At a minimum of four months after the surgery, “patient satisfaction was very high,” the authors of the study write. “Of a possible ten points, patients reported mean satisfaction with appearance of 8.4, with feeding of 8.1, with speech of 8.7 and with smile function of 7.1.” Photographs taken of the patients were graded by 21 physicians at Johns Hopkins. “Four patients were physician-graded as excellent to superb. The other three patients were rated as having good postoperative results.”

Movement in each patient´s mouth muscles was assessed by measuring the position of the muscles at rest and again when the patient contracted just the temporalis muscle. Movement was identified in all patients following the procedure, with measurements ranging from 1.6 millimeters to 8.5 millimeters and an average of 4.2 millimeters.

“Temporalis tendon transfer is a relatively easy procedure to perform that has distinct advantages compared with other forms of facial reanimation and provides very good results,” the authors conclude.; Source: JAMA and Archives Journals