St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, UK.
St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, UK.
J Plast Reconstr Aesthet Surg. 2020 Dec;73(12):2185-2195. doi: 10.1016/j.bjps.2020.05.059. Epub 2020 May 26.
Mini-temporalis transposition (MTT) flaps, modified from Gillies' technique, have become less popular than temporalis tendon transfers for midface reanimation. MTT involves raising the middle third of the temporalis, transposition over the zygomatic arch and lengthening with deep temporalis fascia which is sutured to the orbicularis oris.
This retrospective study assessed subjective and objective outcomes following MTTs by a single surgeon from 2009 to 2019.
Operative and surgical details were recorded. Four blinded consultants rated pre- and postoperative videos according to Terzis' scale. Pre- and postoperative resting, Mona Lisa and canine smile photographs were analysed using Emotrics, the software that automatically computes differences in inter-landmark distances. Patients also completed the Glasgow Benefit Inventory (GBI) patient-rated outcome measure.
Forty-one patients (mean age 65.8 ± 15.5) underwent MTT, median 3 (0.4-57) years post-paralysis and were followed up for median of 2.2 (0.4-8.8) years. Higher mean postoperative Terzis score demonstrates symmetric and aesthetic improvements (3 ± 1.3 vs. 2 ± 1; p<0.05). Emotrics analysis showed postoperative improvements in resting and dynamic symmetry of all indices, with the majority statistically significant (p<0.003). The mean GBI was 35.19 with 17 (94.4%) patients reporting improvement, whereas one (5.6%) patient reported detriment after surgery. Two (5.4%) patients suffered complications: one haematoma and one infection. Four patients (9.8%) required revisional flap tightening. No patients requested revisional surgery for temporal hollowing or zygomatic fullness.
MTT effectively improves both subjective and objective resting and dynamic midface symmetry in a single stage. These results suggest this technique is a good alternative to temporalis tendon transfer techniques.
迷你颞肌转移（MTT）皮瓣是从吉勒斯技术改良而来，在中面部再神经支配中，其应用已不如颞肌肌腱转移术那么广泛。MTT 涉及提起颞肌的中三分之一，穿过颧弓并延长，用深颞筋膜缝合到口轮匝肌。
本回顾性研究评估了 2009 年至 2019 年间一位外科医生采用 MTT 治疗的患者的主观和客观结果。
记录手术和手术细节。四位盲法顾问根据 Terzis 量表对术前和术后视频进行评分。使用 Emotrics 分析术前和术后的静态、蒙娜丽莎微笑和犬齿微笑照片，Emotrics 软件可自动计算标志点之间距离的差异。患者还完成了格拉斯哥获益量表（GBI）患者自评量表。
41 例患者（平均年龄 65.8±15.5 岁）接受了 MTT，平均病程 3（0.4-57）年，平均随访时间为 2.2（0.4-8.8）年。较高的平均术后 Terzis 评分表明对称性和美学改善（3±1.3 与 2±1；p<0.05）。Emotrics 分析显示，所有指数的静态和动态对称性均有术后改善，其中大部分具有统计学意义（p<0.003）。GBI 平均为 35.19，17 例（94.4%）患者报告改善，1 例（5.6%）患者报告术后恶化。有 2 例（5.4%）患者发生并发症：1 例血肿，1 例感染。4 例（9.8%）患者需要行皮瓣收紧修正术。没有患者因颞部凹陷或颧骨饱满要求行修正手术。
MTT 可在一个阶段内有效改善主观和客观的中面部静态和动态对称性。这些结果表明，该技术是颞肌肌腱转移技术的良好替代方法。
