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Journal of Plastic, Reconstructive & Aesthetic Surgery (2012) 65 , 851 e 856

Refinements in smile reanimation: 10-Year experience with the lengthening Temporalis Myoplasty

Charles Nduka a , Marc-James Hallam a, *, Daniel Labbe b

a Queen Victoria Hospital, Holtye Road, East Grinstead, RH19 3DZ, United Kingdom b 4 Place Fontette, 14000 Caen, France

Received 11 August 2011; accepted 4 February 2012

KEYWORDS Facial reanimation;

Abstract The lengthening Temporalis Myoplasty (LTM) is an innovative dynamic facial reani mation procedure that has been used to great effect following its conception during the early 1990s by the senior author. Since its first description in the literature the technique has been refined and it has become clear from correspondence that certain technical aspects of the procedure require particular attention to detail. We discuss from experience of more than a hundred cases and highlight not only the important technical aspects of the procedure but also the importance of pre-operative assessment and the avoidance of complications. ª 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Facial palsy; Lengthening

temporalis myoplasty; Labbe procedure

may still leave a patient with a significant facial hypo kinesis. The goal for the majority of patients with a facial palsy should therefore be to achieve a dynamic rehabili tation, allowing such expressions as smiling. 3 Smile rean imation is probably the most challenging aspect when rehabilitating the paralysed face. The functional and aesthetic outcome from replacing the many muscles that normally act on the mouth to produce a smile with one or perhaps two muscles 4 will inevitably be limited. Since 1994 the senior author (D.L.) has performed more than a hundred smile reanimations using the Lengthening Temporalis Myoplasty (LTM). 5,6 This technique is superfi cially similar to the technique described by McLaughlin 7 but with some important advantageous modifications. 6 Crucially, the temporalis is directly inserted from the alar

Introduction

The functional, cosmetic and psychological effects of long standing facial palsy are considerable. The associated functional sequelae may include ocular injury leading to blindness, nasal obstruction, oral incompetence, and lip biting. 1 These cosmetic and psychological sequelae should not be underestimated as there is a high reported incidence of depression in affected individuals. 2 Whilst static suspension is often sufficient to improve facial symmetry at rest, it has by definition, no dynamic component and thus

* Corresponding author. Tel.: þ 44 01342414000. E-mail address: mj_hallam@hotmail.co.uk (M.-J. Hallam).

1748-6815/$ - see frontmatter ª 2012BritishAssociationofPlastic, ReconstructiveandAestheticSurgeons. PublishedbyElsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2012.02.006