I thank the authors for their commentary. Allow me to respond to some very salient points that they bring up regarding my article entitled, “Lengthening Temporalis Myoplasty for Single-Stage Smile Reconstruction in Children with Facial Paralysis” in the April of 2016 edition of Plastic and Reconstructive Surgery.1 First, the article does not seek to supplant the gracilis muscle transfer (either one- or two-stage varieties) with the temporalis technique described by Labbé and Huault. As the authors point out, the goal of spontaneity can only be achieved truly with a two-stage facial reanimation technique using a cross-face nerve graft, followed several months later by a gracilis or other muscle transplant. The goal in this situation is to make the activation of the transplanted muscle as seamless as possible by using the functioning contralateral facial nerve. From a functional standpoint, nothing can replace the spontaneity that can be achieved in this setting. However, spontaneity aside, an argument can be made regarding the overall appearance of the patient postoperatively in comparison with other available techniques. This is a highly subjective comparison. The purpose of my article is to highlight my experience with the lengthening temporalis myoplasty in a largely pediatric practice. As I summarized in the article, the lengthening temporalis myoplasty is far from perfect and still carries a high revision rate for several theoretical reasons that I am confident will be remedied as experience grows with this technique. Therefore, for the purpose of training impressionable young plastic surgeons, I am in agreement with classic teaching regarding reanimation for facial paralysis by preferring the use of a functioning facial nerve when available. However, one cannot argue that there are still drawbacks with the procedure with regard to cheek bulk, increased operative times, hospitalization requirements, longer time intervals to animation, and the difficulty of performing meaningful revisions. These factors must also be taken into account and weighed against the goal of spontaneity. Ultimately, the message of my article is to present options so that patients can make informed decisions about their own preferences for reconstruction. I strongly believe in empowering patients in my practice and in all aspects of their care.
The author has no financial interest to declare in relation to the content of this communication.
Andre Panossian, M.D.
Keck School of Medicine at the University of Southern
Los Angeles, Calif.
1. Panossian A. Lengthening temporalis myoplasty for single-stage smile reconstruction in children with facial paralysis. Plast Reconstr Surg. 2016;137:12511261.
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