The Utilization of the Temporal Muscle and Fascia in Facial Paralysis.

T HE temporal muscle and fascia can be utilized to give anchorage for fascial strips in facial paralysis, and some degree of emotional expression may be developed, if the patient will train the newly substituted fifth nerve muscle and will avoid overactivity of the sound side of the face (Figs. 1, 2 and 3). Mechanical support, of course, should not be relied upon when nerve anasto-mosis is possible; but, where the distal branches of the nerve have been torn out-in partial paralysis where it is thought definitely best not to disturb the function already present-and in congenital paralysis, the operation outlined herein is applicable. Summary of Previous Work.-For direct nerve suture and free nerve transplant , the work of Ballance and Duel1 has developed much interest in the past few years. Anastomosis with other motor nerves has been effected by many surgeons, and the photographs of patients that showed excellent emotional expression have been recorded. used strips of temporal fascia turned downward over the zygoma to support the face. published the results of extensive work on the free transplantation of fascia, and the first report of free fascial strips to support the paralyzed face was made by Blair in 1926. Since this time, descriptions have been made of various methods of fixation of the fascial strips, of use of the opposite frontalis and of flaps of the ma,sseter and temporal muscles from the same side. Operation for Combining Temporal Muscle and Free Faha Support.-After consideration and observation of these different methods, a combination plan of operation was developed, in which free fascial strips are put subcutane-ously through the face and are anchored directly into the temporal muscle and fascia through an opening in the temporal region (hair-bearing area) (Figs, 1 and 2). Technic of Obtaining Pas&a.-Careful removal of very long strips of fascia lata is accomplished with the Masson or other suitable stripper. An incision is made above the knee about 6 cm. long, and the subcutaneous tissue is carefully separated from the fascia upward, the length of the dissecting scissors; this separation helps in getting the stripper started. At times there are a good many transverse fibers as a separate layer over the longitudinal fibers, and these can be opened through, as they are of no benefit and hinder the action of the stripper, Three or more strips about 1 cm. wide are removed, it being very advantageous to …