American Association of Plastic Surgeons

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Modifications of the Lengthening Temporalis Myoplasty for Smile Reanimation in Facial Paralysis
Andre Panossian, MD.
Shriners Hospital for Children, Pasadena, CA, USA.

PURPOSE: The lengthening temporalis myoplasty (LTM) as popularized by Daniel Labbé is an important option in treating facial paralysis. Advantages include improved operative times, minimal cheek bulk, avoidance of unusual dimpling, simultaneous bilateral reconstruction, revisability, and ability to perform on an outpatient basis. However, the learning curve is steep and requires modifications to improve reproducibility.
METHODS: A single-surgeon retrospective review was performed between 2012 and 2018, examining patients undergoing smile reanimation using LTM. Patient demographics, diagnosis, operative time, smile excursion, laterality, complications, and length of stay were recorded. Photos and video were obtained for all patients both pre- and postoperatively. Modifications to the original procedure included anterior hairline incision, subzygomatic dissection, aggressive muscle mobilization, and neuroplasty of deep temporal nerves.
RESULTS: A total of 32 patients underwent smile reanimation between 2012 and 2018 using LTM. Twenty-three patients underwent unilateral and 9 patients underwent bilateral procedures. Average operative times for unilateral LTM was 242 minutes, and bilateral LTM was 412 minutes. Smile excursion averaged 8.5 mm (range 5-17 mm). There were no failures but approximately 15 patients (46%) required at least one revision to re-establish movement due to tendon avulsion and/or adhesions. These occurred early in the series. An additional 3 patients demonstrated temporal hollowing, requiring fat injection.
CONCLUSION: Lengthening temporalis myoplasty produces decreased cheek bulk, shorter operative times, ease of on-table adjustments and revisions, and outpatient surgery over other techniques. Despite modest revision rates for LTM, the modifications described reduced this rate to 0 in the final 12 patients.


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