• Maxillofacial Plastic and Reconstructive Surgery
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• 제40권
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• pp.24.1-24.6
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• 2018

Temporalis tendon transfer is a technique for dynamic facial reanimation. Since its inception, nearly 80 years ago, it has undergone a wealth of innovation to produce the modern operation. Temporalis tendon transfer is a relatively minimally invasive technique for the dynamic reanimation of the paralyzed face. This technique can produce significant and appropriate movement of the lateral oral commissure, more closely mimicking the normal side. The aim of this article is to review the technique of temporalis tendon transfer involving transferring of the coronoid process of the mandible with the insertion of the temporalis tendon via intra-oral and transcutaneous approach.

• Archives of Plastic Surgery
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• 제50권1호
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• pp.42-48
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• 2023

Background The temporalis muscle flap transfer with fascia lata augmentation (FLA) is a promising method for smile reconstruction after facial palsy. International literature lacks a detailed anatomical analysis of the temporalis muscle (TPM) combined with fascia lata (FL) augmentation. This study aims to describe the muscle's properties and calculate the length of FL needed to perform the temporalis muscle flap transfer with FLA. Methods Twenty nonembalmed male (m) and female (f) hemifacial cadavers were dissected to investigate the temporalis muscle's anatomy. Results The calculated minimum length of FL needed is 7.03cm (f) and 5.99cm (m). The length of the harvested tendon is 3.16cm/± 1.32cm (f) and 3.18/± 0.73cm (m). The length of the anterior part of the temporalis muscle (aTPM) is 4.16/± 0.80cm (f) and 5.30/± 0.85cm (m). The length of the posterior part (pTPM) is 5.24/± 1.51cm (f) and 6.62/± 1.03cm (m). The length from the most anterior to the most posterior point (aTPMpTPM) is 8.60/± 0.98cm (f) and 10.18/± 0.79cm (m). The length from the most cranial point to the distal tendon (cTPMdT) is 7.90/± 0.43cm (f) and 9.79/± 1.11cm (m). Conclusions This study gives basic information about the temporalis muscle and its anatomy to support existing and future surgical procedures in their performance. The recommended minimum length of FL to perform a temporalis muscle transfer with FLA is 7.03cm for female and 5.99cm for male, and minimum width of 3 cm. We recommend harvesting some extra centimeters to allow adjusting afterward.

• Archives of Plastic Surgery
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• 제40권4호
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• pp.348-352
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• 2013

Background Temporalis muscle transfer produces prompt surgical results with a one-stage operation in facial palsy patients. The orthodromic method is surgically simple, and the vector of muscle action is similar to the temporalis muscle action direction. This article describes transferring temporalis muscle insertion to reconstruct incomplete facial nerve palsy patients. Methods Between August 2009 and November 2011, 6 unilateral incomplete facial nerve palsy patients underwent surgery for orthodromic temporalis muscle transfer. A preauricular incision was performed to expose the mandibular coronoid process. Using a saw, the coronoid process was transected. Three strips of the fascia lata were anchored to the muscle of the nasolabial fold through subcutaneous tunneling. The tension of the strips was adjusted by observing the shape of the nasolabial fold. When optimal tension was achieved, the temporalis muscle was sutured to the strips. The surgical results were assessed by comparing pre- and postoperative photographs. Three independent observers evaluated the photographs. Results The symmetry of the mouth corner was improved in the resting state, and movement of the oral commissure was enhanced in facial animation after surgery. Conclusions The orthodromic transfer of temporalis muscle technique can produce prompt results by applying the natural temporalis muscle vector. This technique preserves residual facial nerve function in incomplete facial nerve palsy patients and produces satisfying cosmetic outcomes without malar muscle bulging, which often occurs in the turn-over technique.

• 대한두개안면성형외과학회지
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• 제21권6호
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• pp.351-356
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• 2020

Background: We have devised a novel surgical method, termed as temporalis muscle tendonperiosteum (T-P) compound surgical method, by modifying pre-existing techniques. Our method is characterized by elevation of temporalis muscle tendon and the periosteum of the mandibular ramus as a single compound. Here, we describe the concept and clinical outcomes of our method. Methods: We conducted both a cadaveric study and a clinical study. First, we used four human cadavers (two males and two females) to confirm the anatomy of the temporalis muscle tendon and availability of sufficient length extension through the elevation of the T-P compound. Moreover, we obtained measurements of the mouth angle and the philtrum angle from a total of six patients (two males and four females) and compared them between preoperatively and postoperatively. Results: The mean length of the periosteal portion was measured as 2.43± 0.15 cm (range, 2.2-2.6 cm). There was an improvement in the mouth angle postoperatively as compared with preoperatively (7.2°± 3.0° vs. 14.5°± 4.7°, respectively). Moreover, there was also an improvement in the philtrum angle postoperatively as compared with preoperatively (7.2°± 3.4° vs. 17.2°± 6.5°, respectively). Conclusion: Our method is a simple, minimally-invasive modality that is effective in achieving good clinical outcomes. Its advantages include an ability to achieve a firm extension of the temporalis muscle tendon as well as a lack of requirement for a donor site that may cause complications.

• Archives of Plastic Surgery
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• 제34권3호
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• pp.325-329
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• 2007

Purpose: Mobius syndrome is a rare congenital disorder characterized by facial diplegia and bilateral abducens palsy, which occasionally combines with other cranial nerve dysfunction. The inability to show happiness, sadness or anger by facial expression frequently results in social dysfunction. The classic concept of cross facial nerve grafting and free muscle transplantation, which is standard in unilateral developmental facial palsy, cannot be used in these patients without special consideration. Our experience in the treatment of three patients with this syndrome using transfer of muscles innervated by trigeminal nerve showed rewarding results. Methods: We used bilateral temporalis muscle elevated from the bony temporal fossa. Muscles and their attached fascia were folded down over the anterior surface of the zygomatic arch. The divided strips from the attached fascia were passed subcutaneously and anchored to the medial canthus and the nasolabial crease for smiling and competence of mouth and eyelids. For the recent 13 years the authors applied this method in 3 Mobius syndrome cases- 45 year-old man and 13 year-old boy, 8 year-old girl. Results: One month after the surgery the patients had good support and already showed voluntary movement at the corner of their mouth. They showed full closure of both eyelids. There was no scleral showing during eyelid closure. Also full closure of the mouth was achieved. After six months, the reconstructed movements of face were maintained. Conclusion: Temporalis muscle transfer for Mobius syndrome is an excellent method for bilateral reconstruction at one stage, is easy to perform, and has a wide range of reconstruction and reproducibility.

• Archives of Plastic Surgery
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• 제39권4호
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• pp.345-351
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• 2012

Background Cranial base defects are challenging to reconstruct without serious complications. Although free tissue transfer has been used widely and efficiently, it still has the limitation of requiring a long operation time along with the burden of microanastomosis and donor site morbidity. We propose using a reverse temporalis muscle flap and calvarial bone graft as an alternative option to a free flap for anterior cranial base reconstruction. Methods Between April 2009 and February 2012, cranial base reconstructions using an autologous calvarial split bone graft combined with a reverse temporalis muscle flap were performed in five patients. Medical records were retrospectively analyzed and postoperative computed tomography scans, magnetic resonance imaging, and angiography findings were examined to evaluate graft survival and flap viability. Results The mean follow-up period was 11.8 months and the mean operation time for reconstruction was $8.4{\pm}3.36$ hours. The defects involved the anterior cranial base, including the orbital roof and the frontal and ethmoidal sinus. All reconstructions were successful. Viable flap vascularity and bone survival were observed. There were no serious complications except for acceptable donor site depressions, which were easily corrected with minor procedures. Conclusions The reverse temporalis muscle flap could provide sufficient bulkiness to fill dead space and sufficient vascularity to endure infection. The calvarial bone graft provides a rigid framework, which is critical for maintaining the cranial base structure. Combined anterior cranial base reconstruction with a reverse temporalis muscle flap and calvarial bone graft could be a viable alternative to free tissue transfer.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제42권
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• pp.2.1-2.6
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• 2020

Background: Facial palsy treatment comprises static and dynamic techniques. Among dynamic techniques, local temporalis transposition represents a reliable solution to achieve facial reanimation. The present study describes a modification of the temporalis tendon transfer using a cryopreserved fascia allograft. Case presentation: Between March 2015 and September 2018, seven patients with facial palsy underwent facial reanimation with temporalis tendon transfer and fascia lata allograft. Patients with long-term palsy were considered, and both physical and social functions were evaluated. The mean follow-up time was 21.5 months. No immediate complications were observed. Patients reported improvement in facial symmetry both in static and dynamic. Improvement was noticed also in articulation, eating, drinking, and saliva control. The Facial Disability Index revealed an improvement both in physical function subscale and in the social/well-being function subscale. Conclusions: This modified orthodromic technique allows to reduce the operative time and the risk of complications connected to the use of autologous tissues. The use of the cryopreserved fascia allografts from cadaveric donors seems to provide promising and long-standing results in the treatment of facial palsy.

• Archives of Plastic Surgery
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• 제47권2호
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• pp.198-199
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• 2020

• Maxillofacial Plastic and Reconstructive Surgery
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• 제12권2호
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• pp.55-61
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• 1990

Patients with facial paralysis, in whom nerve damage is irreparable or in whom the innervation of the paralyzed musculature cannot be restored by nerve suture, grafting, or cross-face nerve transplantation, should be offered some form of reconstructive static and dynamic aid. Temporalis muscle-fascia unit used as a circumorbital sling and motor unit is a dynamic controlled reconstructive procedure, but it has several disadvantages such as wide surgical exposure, bulky-looking at lateral canthal area, insufficient voluntary control. This is a case report of facial palsy of posttraumatic lagophthalmos of 41-year-old male, which was corrected by temporalis muscle-tendon transfer with plantaris tendon transplantation.

• The Journal of Korean Physical Therapy
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• 제34권6호
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• pp.321-325
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• 2022

Purpose: Temporomandibular disorder (TMD) is a condition defined as pain and dysfunction of temporomandibular joints and masticatory muscles. Abnormal interconnections between temporomandibular muscles and cervical spine structures can cause the changes of postural alignment and balance ability. The aim of this study was to investigate changes in static balance ability in subjects with painrelated TMD. Methods: This study conducted on 25 subjects with TMD and 25 control subjects with no TMD. Pressure pain thresholds (PPTs) of the masseter and temporalis muscles were measured using a pressure algometer. Static balance ability was assessed during one leg standing using an Inertial Measurement Unit (IMU) sensor. During balance task, the IMU sensors measured motion and transfer movement data for center of mass (COM) motion, ankle sway and hip sway. Results: PPTs of masseter and temporalis muscles were significantly lower in the TMD group than in the control group (p<0.05). One leg standing, hip sway, and COM sway results were significantly greater in the TMD group (p<0.05), but ankle sways were not different between group. Conclusion: We suggest pain-related TMD is positively related to reduced PPTs of masticatory muscles and to static balance ability. These results should be considered together with global body posture when evaluating or treating pain-related TMD.