A technique for facial reanimation: The partial temporalis muscle-tendon transfer with a fascia lata sling

SummaryBackgroundThis report describes the results of a surgical procedure for facial reanimation. This single-stage technique involves the orthodromic transfer of only a superficial segment of the temporalis tendon. This is extended with fascia lata to achieve elevation of the oral commissure along the desired vector in the paralysed hemi-face.MethodsA retrospective case note review was performed. Patients' photographs were objectively evaluated with Facial Assessment by Computer Evaluation (FACE) software.ResultsThirty-nine patients underwent the procedure from 2001 to 2011. Median age at the operation was 57.0 years (interquartile range (IQR) 38.2-66.3 years), and median duration of follow-up was 0.9 years (IQR 0.5-1.8 years). All patients achieved early improvements in appearance and function after surgery. Three patients underwent further, minor procedures for aesthetic and functional adjustments around the oral commissure. Complications occurred in three patients: two minor facial haematomas and one thigh wound infection. The surgery did not disturb natural temporalis muscle function.FACE analysis demonstrated that no significant movement of the oral commissure occurred during attempted smiling in the paralysed hemi-face before surgery. However, symmetry was achieved when the healthy and paralysed hemi-faces were compared post-operatively, both in repose and during controlled smiling.ConclusionsThis modified, single-stage technique for facial reanimation improves commissure mobilisation and has been objectively shown to restore symmetry of the commissure to the reanimated hemi-face.