We read with interest the article “Lengthening Temporalis Myoplasty for Single-Stage Smile Reconstruction in Children with Facial Paralysis” by Panossian.1 The author has presented his experience with the technique initially popularized by Labbé and Huault.2 The author has demonstrated favorable results with the technique and has enumerated various benefits of the procedure over microvascular gracilis transfer, including elimination of the microvascular component and shorter operative time. We feel the intended comparison presented throughout the article may not be valid because each of these techniques is used with different goals. Microvascular gracilis muscle transfer intends to recreate spontaneous smile in addition to achieving balance at rest and dynamic restoration of facial function.3,4 Although there have been reports of “effortless smile activation,” this banks heavily on cortical plasticity in response to prolonged muscle retraining.5 From a purist viewpoint, the regional muscle transfer can possibly be compared against gracilis muscle transfer only when using nerve to masseter as a donor.
When used with classic cross-face nerve grafting, the gracilis microvascular transfer is a different procedure with an inherently different endpoint of reconstruction (i.e., creation of spontaneous dynamic smile). This distinction is especially required from the perspective of young plastic surgery trainees with fairly impressionable thought processes. We really appreciate the work of the author and only want to bring forth the disadvantage of transferring a regional masticatory muscle for smile restoration.
The authors have no financial interest to declare in relation to the content of this communication.
Atul Parashar, M.S., M.Ch.
Ramesh K. Sharma, M.S., M.Ch.
Department of Plastic Surgery
Post Graduate Institute of Medical Education and Research
1. Panossian A. Lengthening temporalis myoplasty for single-stage smile reconstruction in children with facial paralysis. Plast Reconstr Surg. 2016;137:12511261.
2. Labbé D, Huault M. Lengthening temporalis myoplasty and lip reanimation. Plast Reconstr Surg. 2000;105:12891297; discussion 1298.
3. Zuker RM, Manktelow RT, Hussain G. Mathes SJ. Facial paralysis. In: Plastic Surgery. 2006:Vol. 3, 2nd ed. Philadelphia: Saunders; 883916.
4. Fattah A, Borschel GH, Manktelow RT, Bezuhly M, Zuker RM. Facial palsy and reconstruction. Plast Reconstr Surg. 2012;129:340e352e.
5. Blanchin T, Martin F, Labbe D. Lengthening temporalis myoplasty: A new approach to facial rehabilitation with the “mirror-effect” method (in French). Ann Chir Plast Esthet. 2013;58:632637.
Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article’s publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor.
Letters submitted should pose a specific question that clarifies a point that either was not made in the article or was unclear, and therefore a response from the corresponding author of the article is requested.
Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS’ enkwell, at www.editorialmanager.com/prs/.
We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium.
The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.
The Journal requests that individuals submit no more than five (5) letters to Plastic and Reconstructive Surgery in a calendar year.