Department of Plastic and Reconstructive Surgery, Juntendo University Urayasu Hospital, Tomioka Urayasu-city, Chiba.
Department of Plastic and Reconstructive Surgery, AOI international Hospital, Tamachi Kawasaki-city, Kanagawa, Japan.
J Craniofac Surg. 2022 May 1;33(3):926-930. doi: 10.1097/SCS.0000000000008207. Epub 2021 Oct 12.
Lengthening temporalis myoplasty (LTM) is a unique and definite facial reanimation procedure that involves inserting the whole temporal tendon directly into the nasolabial fold. However, the nasolabial fold incision remains one of the difficulties of this procedure, particularly in young or female patient. To avoid the need for this incision, the authors developed an intraoral approach to manipulate the temporal muscle tendon toward the nasolabial fold. in this study, we describe the details of this procedure.
The authors performed their intraoral approach procedure in 5 patients with established complete facial paralysis. instead of making an incision at the nasolabial fold to approach the coronoid process, the authors made the incision at the buccal mucosa. The results were evaluated both subjectively and objectively.
The authors achieved facial reanimation without leaving any obvious scar on the face or neck and the effect of static reconstruction is obvious, even immediately after the surgery. All the patients obtained good facial movement within 4 months (2.5 months in average), and improved all evaluated parameters postoperatively. No infections or other major complications were reported following surgery; however, 1 patient developed a slight dimple that required revision.
The authors could advance temporal tendon toward nasolabial fold firmly obtaining sufficient surgical field similar to that of nasolabial fold incision, and achieved fairly good results without an obvious scar on the face.Establishing LTM without nasolabial fold incision, we could expand the indication of LTM more widely, and it could be more familiar procedure for smile reanimation in all generation.
延长颞肌肌皮瓣（LTM）是一种独特而明确的面部神经再支配手术，涉及将整个颞肌腱直接插入鼻唇沟。然而，鼻唇沟切口仍然是该手术的难点之一，尤其是在年轻或女性患者中。为了避免这种切口的需要，作者开发了一种经口入路来操纵颞肌肌腱向鼻唇沟方向移动。在本研究中，我们描述了该手术的详细过程。
作者对 5 例已确诊的完全性面瘫患者进行了经口入路手术。作者没有在鼻唇沟处做切口来接近喙突，而是在颊黏膜处做切口。对结果进行了主观和客观评估。
作者实现了面部神经再支配，面部或颈部没有留下明显的疤痕，静态重建效果明显，甚至在手术后即刻即可看到。所有患者在 4 个月内（平均 2.5 个月）获得了良好的面部运动，术后所有评估参数均得到改善。术后无感染或其他重大并发症发生；然而，1 例患者出现轻微酒窝，需要再次手术修复。
作者可以将颞肌腱牢固地向前推进到鼻唇沟，获得与鼻唇沟切口相似的充足手术视野，并取得相当好的效果，且面部无明显疤痕。不做鼻唇沟切口进行 LTM 术，可以更广泛地扩大 LTM 的适应证，对于各个年龄段的微笑再支配手术来说，它将变得更加熟悉。
