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Uses of the Superficial Temporal Fascial Flap in Facial Paralysis

Terzis, Julia K. M.D., Ph.D.; Olivares, Fatima S. M.D.

Plastic and Reconstructive Surgery: December 2008 - Volume 122 - Issue 6 - p 176e-185e
doi: 10.1097/PRS.0b013e31818dc012
Reconstructive: Head and Neck: Original Articles

Background: The superficial temporal fascia merits its popularity in reconstructive surgery for its large number of clinical applications. In this report, the authors present their experience with different uses of the superficial temporal fascial flap in facial reanimation.

Methods: Seventeen cases are presented. In 10 patients, the fascial flap provided a vascularized lining at the interface between the free muscle flap for smile restoration and the overlying skin. In six cases, it was utilized to correct small or moderate contour deficits in the paretic hemiface, using either the fascial flap alone or in combination with free adipose tissue. One patient presented with facial paralysis and Frey syndrome following parotidectomy, and the fascial flap was used to control gustatory sweating. Five independent observers graded aesthetic and functional outcomes on a scale from poor to excellent. Three patients were lost to follow-up, so 14 cases were evaluated.

Results: Follow-up ranged from 1 to 216 months (47 ± 60.49 months). The specific reconstructive goal for each patient was achieved and the overall symmetry was greatly improved, with all patients being granted higher scores by the panel of observers following the superficial fascia flap (Wilcoxon matched-pairs signed ranks, p < 0.0001). Transient or permanent alopecia along the temporal incision was the main complication observed.

Conclusions: Transfer of the superficial temporal fascia flap is a valuable technique with several potential applications in facial paralysis management and reconstructive surgery in general. The advantages of this highly vascularized, gliding, and pliable flap far outweigh the associated minimal complications.

Norfolk, Va.

From the International Institute of Reconstructive Microsurgery, Microsurgery Program, Department of Surgery, Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School.

Received for publication March 11, 2008; accepted June 19, 2008.

Julia K. Terzis, M.D., Ph.D., Microsurgical Research Center, Department of Surgery, Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School, 700 Olney Road, Lewis Hall, Room 2055, Norfolk, Va. 23501,

Disclosure: Neither of the authors has an interest in any of the materials mentioned, and neither one receives funding from any institution or authority. This study was reviewed and approved by the Eastern Virginia Medical School Institutional Review Board.

©2008American Society of Plastic Surgeons