xRead - May 2023

Refinements in smile reanimation

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facial reanimation by neurovascular transfer and standard temporalis techniques did not manage to demonstrate a clear advantage of the former over the latter. 19 Also it is important to note is that patients not only have voluntary control of their smile but also can develop spontaneity. This was shown in a small case series where 4 out of 5 patients had developed a truly spontaneous smile between 5 and 10 months postoperatively. 23 Although the LTM has superficial similarities to the McLaughlin technique, it is fundamentally different in two important respects. Firstly, the tendon is attached directly to the site of insertion. This has two advantages; firstly

performed in approximately 2 h, and can be performed on patients of any age. Its principle advantages over neuro vascular transfers are that it avoids temporal hollowing, there is no bulge created in the cheek, the temporalis tendon passes through a gliding plane of Bichat’s fat pad which prevents tethering to the skin, and the line of pull has both a strong superior and posterior component. The tech nique is also appropriate to use in patients with a partial facial paralysis, as there is no danger to any residual facial nerve function. An important advantage following an LTM is the ability of the patient to smile voluntarily within a few weeks of surgery (Figure 5). Interestingly, a study comparing

(a, b) A picture of a patient both pre- and post-operatively with smile demonstrating the degree of dynamic rean

Figure 5

imation that can be achieved using the LTM technique.