Download PDF
Facial Plast Surg 2015; 31(02): 123-127
DOI: 10.1055/s-0035-1549039
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Lengthening Temporalis Myoplasty: A Surgical Tool for Dynamic Labial Commissure Reanimation

Pierre Guerreschi
1   Department of Plastic and Reconstructive Surgery, Hospital Roger Salengro, Lille Cedex, France
,
Daniel Labbe
2   Department of Plastic and Reconstructive Surgery, Clinique Saint Martin, Caen, France
› Author Affiliations
Further Information

Publication History

Publication Date:
08 May 2015 (online)

    Permissions and Reprints

Abstract

Lengthening temporalis myoplasty (LTM), first described by Labbé in 1997, ensures the transfers of the entire temporal muscle from the coronoid process to the upper half of the lip without interposition of aponeurotic tissue. The temporal muscle changes function because it is entirely mobilized toward another effector: the labial commissure. Thanks to brain plasticity, the muscle loses its chewing function, and after 6 months of speech rehabilitation it acquires its new smiling function. We describe technical points especially the coronoid process approaches both through an upper temporal fossa approach and a lower nasolabial fold approach. Rehabilitation starts 3 weeks after the surgery following a standardized protocol to move from a mandibular smile to a voluntary, then spontaneous, smile in three steps. The LTM is the main part of a one-stage global treatment of the paralyzed face. It constitutes a dynamic palliative treatment usually started at the sequelae stage, 18 month after the outcome of a peripheral facial paralysis. This one-stage procedure is a reproducible and relevant surgical technique in the difficult treatment of peripheral facial paralysis. It allows implementing an active muscle transfer to reanimate the labial commissure and re-create a mobile nasolabial fold.

Keywords

facial palsy - lengthening temporalis myoplasty - dynamic reanimation - muscle transfer - temporal muscle
 

  • References

  • 1 Körte W, Bernhardt M. Ein Fall von Nervenpfropfung: des Nervus facialis auf den Nervus hypoglossus. DMW-Deutsche Medizinische Wochenschrift 1903; 29 (17) 293-295
    PubMedGoogle Scholar
  • 2 Labbé D, Huault M. Lengthening temporalis myoplasty and lip reanimation. Plast Reconstr Surg 2000; 105 (4) 1289-1297 , discussion 1298
    CrossrefPubMedGoogle Scholar
  • 3 Harii K, Ohmori K, Torii S. Free gracilis muscle transplantation, with microneurovascular anastomoses for the treatment of facial paralysis. A preliminary report. Plast Reconstr Surg 1976; 57 (2) 133-143
    Google Scholar
  • 4 Gillies H. Experiences with fascia lata grafts in the operative treatment of facial paralysis: (Section of Otology and Section of Laryngology). Proc R Soc Med 1934; 27 (10) 1372-1382
    PubMedGoogle Scholar
  • 5 McLaughlin CR. Surgical support in permanent facial paralysis. Plast Reconstr Surg (1946) 1953; 11 (4) 302-314
    CrossrefPubMedGoogle Scholar
  • 6 Labbé D. Lengthening of temporalis myoplasty and reanimation of the lips. Technical notes [in French]. Ann Chir Plast Esthet 1997; 42 (1) 44-47
    PubMedGoogle Scholar
  • 7 Labbé D, Bénichou L, Iodice A, Giot J-P. Depressor anguli oris sign (DAO) in facial paresis. How to search it and release the smile (technical note) [in French]. Ann Chir Plast Esthet 2012; 57 (3) 281-285
    CrossrefPubMedGoogle Scholar
  • 8 Guerreschi P, Gahagnon T, Vacher C, Drizenko A, Francke J-P, Labbe D. Masseter muscle termination over the deep surface of the temporal fascia: look out the wrong path. Surg Radiol Anat 2011; 33 (10) 863-868
    CrossrefPubMedGoogle Scholar
  • 9 Labbé D. Lengthening temporalis myoplasty V.2. and lip reanimation [in French]. Ann Chir Plast Esthet 2009; 54 (6) 571-576
    CrossrefPubMedGoogle Scholar
  • 10 Hayashi A, Labbé D, Natori Y , et al. Experience and anatomical study of modified lengthening temporalis myoplasty for established facial paralysis. J Plast Reconstr Aesthet Surg 2015; 68 (1) 63-70
    CrossrefPubMedGoogle Scholar
  • 11 Nduka C, Hallam M-J, Labbe D. Refinements in smile reanimation: 10-year experience with the lengthening temporalis myoplasty. J Plast Reconstr Aesthet Surg 2012; 65 (7) 851-856
    CrossrefPubMedGoogle Scholar
  • 12 Boahene KD, Ishii LE, Byrne PJ. In vivo excursion of the temporalis muscle-tendon unit using electrical stimulation: application in the design of smile restoration surgery following facial paralysis. JAMA Facial Plast Surg 2014; 16 (1) 15-19
    CrossrefPubMedGoogle Scholar
  • 13 Ekman P, Davidson RJ. Voluntary smiling changes regional brain activity. Psychol Sci 1993; 4 (5) 342-345
    CrossrefPubMedGoogle Scholar
  • 14 Lambert-Prou M-P. The temporal smile. Speech therapy for facial palsy patients after temporal lengthening myoplasty [in French]. Rev Stomatol Chir Maxillofac 2003; 104 (5) 274-280
    PubMedGoogle Scholar
  • 15 Blanchin T, Martin F, Labbé D. Lengthening temporalis myoplasty: a new approach to facial rehabilitation with the “mirror-effect” method [in French]. Ann Chir Plast Esthet 2013; 58 (6) 632-637
    CrossrefPubMedGoogle Scholar
  • 16 Tessier P, Delbet JP, Pastoriza J, Lekiefre M. Paralyzed eyelids [in French]. Ann Chir Plast 1969; 14 (3) 215-223
    PubMedGoogle Scholar
  • 17 Terzis JK, Noah ME. Analysis of 100 cases of free-muscle transplantation for facial paralysis. Plast Reconstr Surg 1997; 99 (7) 1905-1921
    CrossrefPubMedGoogle Scholar