I read with interest the article by Gupta et al., although it was just a chance encounter of the article and the journal. I recalled having been shown by my colleague (Dr. Ayyappa T-Personal Communication) a video CD recording of his leprosy patient who was unable to close his eye treated by a combination of the fleshy temporalis muscle and the palmaris longus tendon. The tendon was tied to some fibers of the temporalis muscle and was split into two parts which were passed through the eyelids to meet at the medial canthus of the eye where they were tied to the medial canthal ligament avoiding trauma to the lacrimal sac. Only a passing reference has been made to the use of the palmaris longus by Gupta et al. 2014.
The palmaris longus is one of the most variable muscles of the human body and this fact must be kept in mind by any surgeon contemplating its use in reconstructive surgery. Temporalis muscle along with its fascia is a popular graft for interpositional arthroplasty in temporomandibular joint ankyloses; this surgery may also lead to lagophthalmos. One purpose of any tendon is to allow a muscle to act at a distance without increasing the bulk of the muscle; this is well served by the combination of the palmaris longus tendon and the fleshy temporalis muscle. Use of this combination, however, poses one question: For how long the patient has to open and close the mouth to open and close the eye-is it possible to delink these two activities? Similar question may be asked for hypoglossal-facial and spinal accessory-facial anastomoses: For how long the patient has to move the tongue or to raise the shoulder to express?
Anatomists (and other basic medical scientists) are always keenly interested in close interaction with their clinical counterparts particularly surgeons as their experiences and experiments benefit all the parties concerned including their patients and students.
1. Gupta VP, Gupta P, Gupta R. Is it really a silicone sling assisted temporalis muscle transfer? Indian J Ophthalmol. 2014;62:1179
2. Gupta RC, Kushwaha RN, Budhiraja I, Gupta P, Singh P. Modified silicone sling assisted temporalis muscle transfer in the management of lagophthalmos Indian J Ophthalmol. 2014;62:176–9
3. Bergman RA, Afifi AK, Miyauchi R. Palmaris Longus. Illustrated Encyclopedia of Human Anatomic Variation: Opus I: Muscular SystemLast accessed on 2015 Mar 10 Available from: http://www.anatomyatlases.org/AnatomicVariants/MuscularSystem/Text/P/03Palmaris.shtml
4. Balaji SM. Modified temporalis anchorage in craniomandibular reankylosis Int J Oral Maxillofac Surg. 2003;32:480–5
5. Al-Moraissi EA, El-Sharkawy TM, Mounair RM, El-Ghareeb TI. A systematic review and meta-analysis of the clinical outcomes for various surgical modalities in the management of temporomandibular joint ankylosis Int J Oral Maxillofac Surg. 2015;44:470–82