Lengthening temporalis myoplasty and facial paralysis from birth

Congenital facial paralysis (FP) is present from birth. It can produce major esthetic and functional disorders. It can be from two different etiologies: developmental and acquired. There is no curative treatment for congenital FP and the aim for the plastic surgeon is to restore a smile as symmetrical and as dynamic as possible. For this, two opposite techniques can be used: muscular free flaps and locoregional flaps whose lengthening temporalis myoplasty.

We report our series of 34 congenital FP patients who were operated by lengthening temporalis myoplasty (LTM). We divided the patients into three categories: acquired FP (11 cases), isolated developmental FP (13 cases), and syndromic developmental FP (10 cases). The evaluation of the smile is based on the quality of the commissural course compared to the healthy side and the spontaneity of it.

In the acquired FP group, 100% obtained a spontaneous smile with a postoperative delay of 9.5 months, 12 of the 13 cases of isolated developmental FP (92.7%) after 7.3 months postoperatively, and finally, in the 10 cases of syndromic FP, nine (90%) had a spontaneous smile after 9.7 months.

Muscular free flaps continue to be the gold standard for the reanimation of smile on the FP. To our knowledge, no articles comparing smile restoration using free flap and smile restoration using LTM exist. A comparison of the success rates from different studies shows that both these techniques yield good results and can be used for smile restoration in FP. This technique is faster and easier than a free flap and has a same result, which is why we consider this technique as a reference on smile reanimation in FP.