Temporalis Tendon Transfer for the Treatment of Longstanding Facial Paralysis

Facial paralysis is a devastating condition with a severe emotional impact on patients as it significantly affects appearance and impairs function. Patients complain of not being able to hold food and liquid in their mouth, not being able to speak clearly, and not being able to smile. T h e i n a b i l i t y t o s m i l e i s o f t e n psychologically troubling to patients. This presents a challenging problem for reconstructive surgeons as no single technique can be used to correct this ailment. Rather, a comprehensive plan tailored to the patient and utilizing a variety of procedures must be employed. In cases of paralysis of a short duration (< 1 year), direct reinnervation techniques provide the best result. However, in cases where longstanding facial paralysis is present, this is no longer possible as muscle atrophy and nerve end plate fibrosis would have occurred.2 Options in these cases are limited to either regional muscle transfer3, in which an adjacent muscle is simply transposed to provide movement, or free tissue transfers, in which a distant muscle is completely removed, transposed, and reinnervated.