Tendon Transfer Shows Promise in Correcting Facial Paralysis

Temporalis tendon transfer offers a safe, effective, and simple reconstructive procedure when reinnervation of facial muscles is not an option, a new study claims.

Researchers at the Johns Hopkins University School of Medicine (Baltimore, MD, USA) based this claim on a clinical series of seven consecutive patients. Before surgery, patients underwent comprehensive physical therapy that focused on helping each patient understand how to coordinate individual muscle contraction to produce facial expressions, particularly the smile. The physical therapy resumed after removal of sutures, usually about seven days after surgery. The surgical technique involved both the temporalis muscle and the tendon. The tendon was spread horizontally for 3 to 4 cm and sutured to the perioral musculature and some deep dermis. The reinsertion site for the temporalis tendon was determined on the basis of the dominant musculature in a patient's smile: a more horizontal zygomaticus major insertion versus a more vertical levator labii superioris alaeque nasi insertion.

A minimum of four months after surgery, each patient completed a questionnaire to assess satisfaction with the results. The patients' ratings averaged 8.4 for appearance, 8.1 for feeding, 8.7 for speech, and 7.1 for smile function. Every patient had postsurgical movement, which averaged 4.2 mm at the oral commissure. The only notable complication was a case of postoperative salivary fluid collection that required drainage. Specialists in otolaryngology-head and neck surgery evaluated surgical outcomes on the basis of photographs of the patients. The physicians rated overall outcome as excellent to superb for four patients and good for the other three. The study was published in the July 2007 issue of Archives of Facial and Plastic Surgery.

"Temporalis tendon transfer is a relatively easy procedure to perform that has distinct advantages compared with other forms of facial reanimation and provides very good results. This procedure results in improved form and function, may often be performed in a minimally invasive manner, and eliminates the facial asymmetry typically produced by temporalis transfer,” concluded lead author Patrick Byrne, M.D., and colleagues.


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Johns Hopkins University School of Medicine