Temporalis transplantation for paralytic lagophthalmos.

Under infiltration anaesthesia a hockey-stick incision, about 4 in. long, is made I-5 cm. in front of the tragus (Fig. i). A skin flap is reflected forwards and downwards and the fascia covering the temporalis muscle is exposed. Two parallel and nearly vertical incisions, 2 in. long and 8 mm. apart, are made in the temporalis fascia; these are joined at the base by a horizontal incision. The vertical incisions are extended upwards for 4 mm. on to the periosteum covering the parietal bone, and the upper ends are then joined by another horizontal incision (Fig. 2). The inclusion of the periosteal tag is very important as it serves as the common link between the muscle and its fascia. The muscle fibres start from the periosteum and the fascial fibres merge into the periosteum. Therefore, the fascial strip remains attached to the muscle slip through the periosteal tag and does not come off on pulling. The portion of the temporalis fascia marked out by these incisions is then freed from the muscle up to the level of origin of the muscle fibres; it is reflected upwards (Fig. 3) and split longitudinally into two equal halves (Fig. 4). Two parallel verticle incisions are now made on the muscle deep to the bone along the line of the original fascial incision. The small rectangular