Case report
Recycle of temporal muscle in combination with free muscle transfer in the treatment of facial paralysis

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Summary

We experienced three patients with long-standing unilateral complete facial paralysis who previously underwent temporalis muscle transfer to the cheek for smile reconstruction. All patients complained of insufficient and uncomfortable buccal motion synchronised with masticatory movements and incomplete eyelid closure with ptotic eyebrow.

To attain a near-natural smile and reliable eyelid closure, temporalis muscle was displaced from the cheek to the eyelid, and a neurovascular free latissimus dorsi muscle was transferred for the replacement of cheek motion. As a result, cheek motion synchronised with the contralateral cheek upon smiling and sufficient eyelid closure were obtained in all cases. Smile reconstruction using the temporal muscle is an easy and a versatile way in general. However, spontaneous smile is not achieved and peculiar movement of the cheek while eating is conspicuous in some cases. Replacement with neurovascular free latissimus dorsi muscle and recycling previously used temporalis muscle for eyelid closure are considered to be valuable for such cases.

Section snippets

Background

To date, various static and dynamic procedures have been developed to treat long-standing facial paralysis. As for the cheek reanimation, tempolaris muscle transfer is widely accepted because of its efficiency with a relatively simple procedure, without any loss of other significant functions.1, 2 However, temporalis transfer does not give a spontaneous mimetic smile and necessitates physiotherapy to obtain automaticity.2 On the other hand, free neurovascular muscle transfer is known as an

Surgical methods

After removing a strip of skin above the eyebrow and performing a direct eyebrow lift, the cheek was undermined above the previously transferred temporalis muscle through a pre-auricular incision. In the present three cases, their caudally based rectangular temporalis muscle had been flipped over the zygomatic arch to the cheek pocket and the fascia lata was used as an intermediate graft to the lips. The dissection proceeded to about 1 cm beyond the nasolabial fold. In two of the three cases, a

Case 1

A 57-year-old woman suffered from established right complete facial paralysis after ablative surgery of an intracranial tumour 14 years ago. She had undergone dynamic smile reconstruction with a temporalis muscle transfer and static reconstructive operation for eyelid closure at another hospital. She visited us wanting to improve weak insufficient cheek smile motion that unpleasantly synchronised with bite action, incomplete right eyelid closure and obvious sagging of the eyebrow.

To obtain

Discussion

Our three patients complained of an unnatural cheek motion synchronised with biting. We therefore replaced the transferred temporalis muscle with the free neuromuscular latissimus dorsi muscle innervated by the contralateral facial nerve branch.6 Our present three cases may not be common, but we would like to point out the importance of the selection of the innervating source for smile reconstruction. Although Rubin et al. reported that some patients could obtain a spontaneous smile after

Conflict of interest/funding

None.

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