Hayashi Ayato, Labbé Daniel, Natori Yuhei, Yoshizawa Hidekazu, Kudo Hiroyuki, Sakai Tatsuo, Mizuno Hiroshi
Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan.
Service de Chirurgie Maxillo-faciale et Plastique, Caen University Hospital, Avenue coˆte de Nacre, 14 033 Caen, France.
J Plast Reconstr Aesthet Surg. 2015 Jan;68(1):63-70. doi: 10.1016/j.bjps.2014.09.037. Epub 2014 Sep 28.
Lengthening temporalis myoplasty, reported by Daniel Labbé in 1997, is a unique and definite facial reanimation procedure that involves moving the whole temporal muscle anteroinferiorly and inserting its tendon directly into the nasolabial fold. In the present article, we report our experience in the use of his modified method of the procedure, which preserves the zygomatic arch by transecting the coronoid process through the nasolabial fold incision. We also describe our cadaveric study that aimed to elucidate a secure approach for coronoid process transection. We performed this procedure in five patients with permanent facial paralysis. To improve facial symmetry, we also performed several additional static reconstructions such as T-shaped double-sleeve fascia grafts for lower lip deformities. We were successful in achieving considerable static improvement at rest, immediately after the surgery, and the recovery of facial movement was apparent approximately 3 months after the surgery. With regard to the cadaveric study, we noted that the entry to the buccal fat region, which is also the pathway of the temporal fascia, was a narrow space, and a short transection of the medial upper edge of the masseter fascia would make it easy to locate the coronoid process. Therefore, for a safe and secure access to the coronoid process from the nasolabial fold, we believe that we should first expose the cranial side and continue to dissect along the side and lower edge of the maxilla to locate the medial upper edge of the masseter fascia. By transecting along its edge, we could easily access the coronoid process, located immediately behind it, and widen the pathway of the temporal fascia. This modified method is less invasive and simpler compared to the original procedure, and understanding the detailed anatomy for dissection would help surgeons perform this procedure more confidently.
颞肌延长肌成形术由丹尼尔·拉贝于1997年报道，是一种独特且明确的面部重建手术，该手术将整个颞肌向前下方移动，并将其肌腱直接插入鼻唇沟。在本文中，我们报告了使用他改良手术方法的经验，该方法通过鼻唇沟切口横断冠突来保留颧弓。我们还描述了旨在阐明安全横断冠突方法的尸体研究。我们对5例永久性面瘫患者实施了该手术。为改善面部对称性，我们还进行了一些额外的静态重建，如下唇畸形的T形双袖筋膜移植。术后立即，我们成功在静止状态下实现了显著的静态改善，术后约3个月面部运动恢复明显。关于尸体研究，我们注意到进入颊脂区域（也是颞筋膜的路径）的空间狭窄，咬肌筋膜内侧上缘的短横断会便于定位冠突。因此，为从鼻唇沟安全可靠地进入冠突，我们认为应首先暴露颅骨侧，然后沿着上颌骨的侧面和下缘继续解剖以定位咬肌筋膜的内侧上缘。通过沿其边缘横断，我们可以轻松进入紧位于其后方的冠突，并拓宽颞筋膜的路径。与原始手术相比，这种改良方法侵入性更小且更简单，了解详细的解剖结构有助于外科医生更自信地实施该手术。
