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Smile Reconstruction for Patients with Congenital Incomplete Facial Paralysis using Modified Lengthening Temporalis
Riho Takayanagi1,2, Akiko Hirata3, Akihiro Ogino4
1Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan.
Journal of Plastic and Reconstructive Surgery
|April 8, 2026
Summary
Modified lengthening temporalis myoplasty (LTM) effectively restores smile symmetry in patients with congenital incomplete facial nerve paralysis, offering a scarless surgical option for improved quality of life.
Area of Science:
- Plastic Surgery
- Otolaryngology
- Pediatric Surgery
Background:
- Congenital facial paralysis often presents with mild, resting asymmetry, leading to delayed treatment.
- Surgical intervention for smile restoration significantly impacts patient quality of life and development.
Purpose of the Study:
- To evaluate the efficacy of modified lengthening temporalis myoplasty (LTM) for facial reanimation in older pediatric patients with congenital incomplete facial nerve palsy.
- To assess smile symmetry post-surgery using a novel objective method.
Main Methods:
- Modified LTM with an extended S-shaped incision was performed on three patients (ages 12-26).
- T-shaped fascial grafts were utilized in two cases for lower lip support.
- Smile symmetry was evaluated objectively postoperatively.
Main Results:
- Follow-up ranged from one to nine years.
- All patients achieved symmetrical oral commissures at rest.
- Good symmetry during voluntary smiling was noted in all patients, and during spontaneous smiling in two.
Conclusions:
- Modified LTM is a viable, scarless surgical technique for smile reconstruction in congenital incomplete facial nerve palsy.
- The procedure does not require microsurgery, making it an accessible option.
