Temporalis Muscle Transposition

Contiguous muscle transposition for restoration of facial tone and movement has been a popular alternative to hypoglossal facial crossover, particularly when the distal nerve is not available or the patient is being treated on a delayed basis. The masseter muscle has been mentioned as a possible donor site, but most current investigators consider this muscle a poor choice because of its short length and suboptimal direction of pull. Temporalis muscle transposition has traditionally been the procedure of choice for facial reanimation if a hypoglossal to facial nerve crossover was not an option. Use of the temporalis muscle for facial reanimation is relatively straightforward and, despite a number of possible complications, they are usually minor. However, there are several shortcomings of temporalis muscle transposition for management of facial paralysis: (1) a temporal depression is left from transfer of the muscle; (2) the bulk of the muscle over the zygoma is usually quite apparent, even with thinning of the underlying zygoma;

(3) the muscle does not always provide a sufficiently strong contraction to bring about significant facial movement;

(4) contraction of the temporalis is not an emotive response and requires training to achieve a semblance of a smile; (5) in order to achieve significant elevation of the upper lip and oral commissure substantial overcorrection is required, which can produce an unsightly appearance, reminiscent of a snarl; (6) the procedure usually requires a general anesthesia with 2 to 3 hours of operating time.

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