Minimally invasive temporalis tendon transposition

Objective: To describe a minimally invasive approach of the temporalis tendon transposition technique for dynamic reanimation in patients with long-standing facial paralysis. Methods:Wereport a case series of17consecutive patients withfacial paralysiswhounderwentminimallyinvasivetemporalis tendon transposition surgery for dynamic facial reanimationbetweenJanuary1,2006, andDecember31,2008. The minimally invasive technique is described. Preoperativeandpostoperativerecords, photographs,andvideoswere reviewedfor feasibility ofthetechnique,symmetry,oralcompetence, and dynamic oral commissure movement. Results: All the patients tolerated the procedure well, and none developed procedure-related complications. All the patients achieved improved symmetry at rest and voluntary motion of the oral commissure. In all the patients, the temporalis tendon was transposed to the modiolus without the need for fascial extension or lengthening myoplasty. Conclusions: The temporalis tendon can be transposed for immediate dynamic reanimation of the paralyzed lower face using aminimally invasive approach. This procedure involves a single small incision and minimal dissection, with no major osteotomies. Acquisition of desired facial movement requires intensive physiotherapy and a motivated patient.