[Lengthening temporalis myoplasty: Technical refinements]

Area of Science:

• Plastic surgery
• Reconstructive surgery
• Facial reanimation

Background:

• Peripheral facial paralysis often results in significant aesthetic and functional deficits.
• Static or dynamic reconstructive techniques are employed to address facial paralysis sequelae.
• The lengthening temporalis myoplasty (LTM) is a dynamic surgical option for facial reanimation.

Purpose of the Study:

• To provide a detailed technical guide for surgeons performing lengthening temporalis myoplasty (LTM).
• To describe the surgical approaches and rehabilitation protocol for LTM.
• To highlight LTM as a component of a one-stage treatment for facial paralysis.

Main Methods:

• Mobilization of the entire temporalis muscle from the coronoid process.
• Transfer of the temporalis muscle to the labial commissure without aponeurotic tissue.
• Surgical approaches include the temporal fossa and nasolabial fold.
• Postoperative rehabilitation follows a standardized 3-step protocol over 6 months.

Main Results:

• The temporalis muscle adapts its function from mastication to smiling due to brain plasticity.
• Successful reanimation of the labial commissure and recreation of a mobile nasolabial fold.
• LTM enables a transition from mandibular to voluntary and spontaneous smiles post-rehabilitation.

Conclusions:

• Lengthening temporalis myoplasty (LTM) is a powerful, reproducible, and relevant surgical technique.
• LTM serves as a dynamic palliative treatment for the sequelae of peripheral facial paralysis.
• This one-stage procedure effectively restores function and aesthetics in the paralyzed face.