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Lengthening Temporalis Myoplasty for Single-Stage Smile Reconstruction in Children with Facial Paralysis

Panossian, Andre M.D.

Plastic and Reconstructive Surgery: April 2016 - Volume 137 - Issue 4 - p 1251–1261
doi: 10.1097/PRS.0000000000002009
Reconstructive: Head and Neck: Original Articles
Cover Article
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Background: Free muscle transfer for dynamic smile reanimation in facial paralysis is not always predictable with regard to cosmesis. Hospital stays range from 5 to 7 days. Prolonged operative times, longer hospital stays, and excessive cheek bulk are associated with free flap options. Lengthening temporalis myoplasty offers single-stage smile reanimation with theoretical advantages over free tissue transfer.

Methods: From 2012 to 2014, 18 lengthening temporalis myoplasties were performed in 14 children for smile reconstruction. A retrospective chart review was completed for demographics, operative times, length of hospital stay, and perioperative complications.

Results: Fourteen consecutive patients with complete facial paralysis were included. Four patients underwent single-stage bilateral reconstruction, and 10 underwent unilateral procedures. Diagnoses included Möbius syndrome (n = 5), posterior cranial fossa tumors (n = 4), posttraumatic (n = 2), hemifacial microsomia (n = 1), and idiopathic (n = 2). Average patient age was 10.1 years. Average operative time was 410 minutes (499 minutes for bilateral lengthening temporalis myoplasty and 373 for unilateral lengthening temporalis myoplasty). Average length of stay was 3.3 days (4.75 days for bilateral lengthening temporalis myoplasty and 2.8 for unilateral lengthening temporalis myoplasty). Nine patients required minor revisions.

Conclusions: Lengthening temporalis myoplasty is a safe alternative to free tissue transfer for dynamic smile reconstruction in children with facial paralysis. Limited donor-site morbidity, shorter operative times, and shorter hospital stays are some benefits over free flap options. However, revisions are required frequently secondary to tendon avulsions and adhesions.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Los Angeles, Calif.

From the Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles.

Received for publication May 6, 2015; accepted November 19, 2015.

Disclosure: The author has no financial interest to declare in relation to the content of this article.

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Andre Panossian, M.D., 9033 Wilshire Boulevard, Suite 200, Beverly Hills, Calif. 90211, drpanossian@drpanossian.com

©2016American Society of Plastic Surgeons