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

Parashar, Atul M.S., M.Ch.; Sharma, Ramesh K. M.S., M.Ch.

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Plastic and Reconstructive Surgery: November 2016 - Volume 138 - Issue 5 - p 950e
doi: 10.1097/PRS.0000000000002692
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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
Chandigarh, India


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.


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