What is temporalis muscle transfer?
Temporalis muscle is a chewing muscle located on the side of the temple and extending to the jaw that helps with jaw closure. There are multiple ways to use temporalis muscle to substitute smile muscle function, your surgeon will determine the optimal technique to approximate most natural smile. Frequently this procedure requires either a transposition of the whole muscle so that it reaches the corner of the mouth (Labbe approach), or extension of the muscle tendon with fascia borrowed from another site in the body in order to avoid tight appearance. The substitution works by transposing the muscle to the corner of the mouth, thus allowing patients to bite down triggering a smile on the side of the transfer.
Temporalis muscle transfer is an option for select patients with facial paralysis where using nerve transfers is not feasible or the smile muscle called zygomaticus major was removed during cancer surgery, following trauma or for patients who were born without smile muscles. Patients with paralysis of more than 2 years may no longer have functional facial muscles may also be a candidate, because the muscles waste away if they are not used. In these circumstances, your surgeon may offer patients either a gracilis muscles transplant or a temporalis muscle transfer. Temporalis muscle may be preferred for patients, who wish to reduce surgical time and risk, or in instances where gracilis muscle transplant did not survive. Most importantly, temporalis transfer only addresses the dynamic smile on the affected side, it has no effect on eye closure or global facial symmetry or tone.
When do I need temporalis muscle transfer surgery?
Facial paralysis surgery is different in all patients, your surgeon will be able to create a custom plan for patientsโ unique situation in order to get the best results. Temporalis muscle transfer is an option for select patients with facial paralysis where using nerve transfers is not feasible or the smile muscle called zygomaticus major was removed during cancer surgery, following trauma or for patients who were born without smile muscles. Patients with paralysis of more than 2 years may no longer have functional facial muscles may also be a candidate, because the muscles waste away if they are not used. hey will need to have a special test called electromyography (EMG), that measures muscle activity to ensure there has been no irreversible muscle wasting. If paralysis has been present for over 2 years or there are signs of muscle significant wasting on EMG, patients often need both a cross-face nerve graft and a muscle transplant from their inner thigh. In these circumstances, your surgeon may offer patients either a gracilis muscles transplant, or a temporalis muscle transfer. Temporalis muscle may be preferred for patients, who wish to reduce surgical time and risk, or in instances where gracilis muscle transplant did not survive.
How do I prepare for temporalis transfer surgery?
Prior to temporalis transfer surgery, your surgeon may get an electromyography (EMG) study of your facial muscles to determine if you are a candidate for the nerve transfers. Nerve transfers are almost always preferred over other reanimation options. Some patients will have a few sessions of facial physiotherapy before surgery to prepare. In certain instances, temporalis muscle transfer may be offered without need for additional testing as patientโs surgical or trauma related history will dictate if itโs an option. Rarely, patients may have already had their temporalis muscle used for other reconstructive facial needs so this procedure is no longer an option.
What happens temporalis transfer surgery?
Patients are taken in to the operating room and surgery is performed under general anesthesia. Facial nerve monitoring may be used if there is residual facial nerve function on the face that is affected. The temporalis muscle is either translocated towards the corner of the mouth or a tendon extension fascia taken from other donor sites (outer thigh, hand, lower leg or temple) and used to lengthen the muscle tendon so that it can reach the corner of the mouth. Patients will be able to trigger smile movement by biting down immediately after surgery.
What are the risks of temporalis transfer surgery?
The risks of surgery will vary depending on what nerve transplant or transfer surgery is performed. The general risks of facial surgery include bleeding, bruising, infection, injury to the movement nerves on the donor sites, temple hollowing, scar in around the mouth (nasolabial fold), numbness, the need for additional surgery, chronic pain, numbness, temporary or permanent loss of facial movement on the functional side risks of general anesthesia. Preparing for surgery and following your doctorโs instructions are useful to help minimize risks.