A Comparison of Temporalis Transfer and Free Latissimus Dorsi Transfer in Lower Facial Reanimation Following Unilateral Longstanding Facial Palsy

Abstract

The ultimate goal in the treatment of facial palsy is the restoration of voluntary and spontaneous movement to the paralyzed side of the face, symmetrical to the normal side. We report our experience treating 40 patients with established facial palsy over a 4-year period. All patients underwent either temporalis transfer or free latissimus dorsi transfer as a single stage to improve lower facial symmetry. We believe that both techniques reliably achieve an increase of movement in facial reanimation after oncological, traumatic, or congenital facial palsy.

Facial Attractiveness

“…Nonetheless, understanding the rules of facial symmetry is of potential value in reconstructive maxillofacial or plastic facial surgery. 17,18,[21][22][23][24][25] For more than a century studies of human facial attractiveness have focused on photographic and digital composites of faces. This has supported the theory that attractive faces approximate those features seen on facial composites ("averageness" hypothesis).…”

An Evidence-Based Approach to Facial Reanimation

“…134 A comparative study examining outcomes following smile reanimation by orthodromic temporalis tendon transfer using intervening strips of fascia lata (29 patients) against free latissimus dorsi transfer powered by branches of the contralateral FN (11 patients) found nonsignificant differences between groups on postoperative Harii smile grade 11 (3.3 vs 3.6, P>.05, respectively) (level IIIb). 139 In summary, evidence supports the effectiveness of surgery in dynamic reanimation of smile with resultant improvement in patient QOL.…”

Surgical management of facial nerve paralysis in the pediatric population

“…These inferiorities include the following: hollowing of the temporal fossa [83] (though this problem can largely be eliminated with meticulous closure of the deep temporal fossa) and limited capacity to create a natural smile and to respond to emotion. Because the temporalis is innervated by the trigeminal nerve and not the facial nerve [84], there is a lower overall functionality when compared with free tissue transfer [85]. The masseter is even more rarely used because of similar inadequacies as those found when using the temporalis.…”