The Combined Transoral and Transfacial Orthodromic Temporalis Tendon Transfer

The orthodromic temporalis tendon transfer (OTTT) has become a popular option for immediate and predictable dynamic facial reanimation. The combined transoral/transfacial (TO/TF) approach utilizes the advantages of other prior approaches with minimal drawbacks. A retrospective chart review of patients that underwent our approach at a single institution was performed. Our stepwise surgical technique was performed in a standardized fashion as described. Outcome measures include (1) resting facial symmetry, (2) dynamic movement with lip excursion, (3) postoperative complications, and (4) rate of revision surgery. Between 2007 and 2020, 49 cases were performed at our institution. The average patient age was 59.5 years old. Two patients were lost to follow-up. Forty-four patients (93.6%) achieved improved resting facial symmetry and 38 patients (80.9%) demonstrated dynamic movement with lip excursion. The rate of all postoperative complications was 21.2% with infection being the most common. The rate of revision surgery was 21.2%. The combined transoraltransfacial OTTT is a minimally invasive, safe, and reliable method to provide static facial symmetry, dynamic motion, and lower lip competence in long-standing facial paralysis patients.