Chen Gang, Yang Xianxian, Wang Wei, Li Qingfeng
From the *Department of Plastic Surgery, Zhujiang Hospital, Southern Medical University, Guangdong, China; †Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Craniofac Surg. 2015 Mar;26(2):518-21. doi: 10.1097/SCS.0000000000001522.
Facial paralysis is a common craniofacial deformity that is responsible for significant psychological and functional impairment. Free muscle transfer in 2 stages and latissimus dorsi transfer in one stage may be the most effective surgical procedure for achieving a symmetrical spontaneous smile for a patient with complete facial paralysis. However, these 2 procedures are unsuitable for many incomplete patients. The authors introduce a less invasive procedure, termed mini-temporalis transposition that is able to achieve a symmetrical spontaneous smile in incomplete patients. Through a zigzag incision into the temporal region, the middle third of the temporalis is transferred and elongated with the palmaris longus tendon or combined with the deep temporal fascia. The strips are anchored to key points at the modiolus and the middle of the ipsilateral orbicularis oris muscle through a small intraoral incision and subcutaneous tunnel. The key points are marked during preoperative smile analysis. This procedure was applied to 15 patients with long-standing incomplete facial paralysis. All patients obtained improvements in smile symmetry after the operation, and patients' satisfaction was high. In addition, no damage to residual facial nerve functions or development of procedure-induced complications (such as a facial contour defect, lip eversion or puckering, or skin tethering) was observed in any of the patients. Nevertheless, slight temporal hollowing was observed in 4 patients, and mild bulkiness over the zygomatic arch was a common observation. In summary, the mini-temporalis transfer technique is a safe and effective method of smile restoration for long-standing incomplete facial paralysis.
面瘫是一种常见的颅面畸形，会导致严重的心理和功能障碍。两阶段游离肌肉移植和单阶段背阔肌移植可能是为完全性面瘫患者实现对称自然微笑的最有效外科手术。然而，这两种手术不适用于许多不完全性面瘫患者。作者介绍了一种侵入性较小的手术，称为颞肌小移位术，该手术能够使不完全性面瘫患者实现对称自然微笑。通过颞部的锯齿状切口，将颞肌的中间三分之一与掌长肌腱一起转移并延长，或与颞深筋膜联合使用。通过一个小的口腔内切口和皮下隧道，将这些条带固定在口角和同侧口轮匝肌中部的关键点上。这些关键点在术前微笑分析时进行标记。该手术应用于15例长期不完全性面瘫患者。所有患者术后微笑对称性均有改善，患者满意度较高。此外，在任何患者中均未观察到残留面神经功能受损或出现手术引起的并发症（如面部轮廓缺陷、嘴唇外翻或起皱、或皮肤束缚）。然而，4例患者出现轻微颞部凹陷，颧弓上方轻度臃肿较为常见。总之，颞肌小移位技术是一种治疗长期不完全性面瘫的安全有效的微笑恢复方法。
