|2009 Annual Meeting Abstracts
OUR EXPERIENCE WITH MINI-TEMPORALIS IN FACIAL REANIMATION
Julia K. Terzis, M.D., Ph.D.1, Fatima S. Olivares, M.D.2.
1Eastern Virginia Medical School, Norfolk, VA, USA, 2Microsurgical Research Center, Norfolk, VA, USA.
Purpose: Segmental temporalis transposition (mini-temporalis) has been used in two groups of patients with established facial paralysis, with distinct criteria: (a) to augment remaining deficit after the “babysitter” procedure (CFNG’s + minihypoglossal transfer) (Group A; n=31); and (b) during the revision stage to correct inadequate results of free muscle transfer for smile reanimation (Group B; n=41). This paper evaluates the usefulness of mini-temporalis in both indications.
Data was gathered from 72 patients who had mini-temporalis at a single institution from 1981 to present. These patients were divided into Group A (primary reconstruction) or Group B (secondary revision). In 65 patients the middle third of the temporalis was used, the posterior third in two, and both segments in five. In all cases of group B except three, mini-temporalis was tunneled underneath the free muscle graft, in a submucosal position. The posterior third of the temporalis was aproximated to the anterior segment to prevent donor hollowing. In five cases a silastic spacer was inserted in the donor site, and in four cases superficial temporal fascia was used. Outcomes of mini-temporalis transfer were evaluated by five independent reviewers using a five grade scale from poor to excellent. Cronbach alpha was calculated for the inter-rater reliability of the observers’ scores (αlpha <0.68). Inclusion criteria demanded a three month or longer follow up, hence, five patients were excluded from evaluation. Significance level was set at 0.05.
All patients demonstrated a significant increase from their preoperative scores with improved symmetry at rest and animation. Needle EMG was available in 77.7% of cases, and demonstrated good electrical activity in all transposed units. In group A (n=31), 60 % of the patients attained good or excellent results, 30 % moderate results and 10 % fair results. In this group, mini-temporalis exhibited a less powerful contraction than a free muscle graft, yet this was balanced out by earlier results, less demanding technique and lower complication rate. In group B, 94 % demonstrated improved scores from those granted after free muscle, and 5.6 % had the same score. In this group, mini-temporalis proved to be a reliable secondary intervention to effectively upgrade inadequate results of free muscle transfer.
In this study, mini-temporalis was shown to be a reliable adjunctive procedure to correct remaining asymmetry following the babysitter procedure and following free muscle transfer.