Keeping the fat on the right spot prevents contour deformity in temporalis muscle transposition.

Publication date: Available online 13 April 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Martinus M. van Veen, Steven F.S. Korteweg, Pieter U. Dijkstra, Paul M.N. Werker
The temporalis muscle transposition is a reliable, one-stage reanimation technique for longstanding facial paralysis. In the variation described by Rubin the muscle is released from the temporal bone and folded over the zygomatic arch towards the modiolus. This results in unsightly temporal hollowing and zygomatic bulging. We present a modification of this technique which preserves the temporal fat pad in its anatomical location, and conceals temporal hollowing and prevents zygomatic bulging.The data of 23 patients treated with this modification were analysed. May classification was used for evaluation of mouth reanimation. Experts and patients scored visibility of the contour deformity on a 100 millimetre VAS score (0 = poor / 100 = best). 3D images of the face were used to measure temporal hollowing and zygomatic bulging. 3D images were compared to those of controls with a similar gender- and age distribution.After a median follow-up of 5.7 years, all patients achieved symmetry at rest. Eleven patients achieved symmetry while smiling with closed lips (May classification "Good"). A median (IQR) VAS score of 19 (6; 41) was given by experts and 25 (5; 59) by patients themselves. 3D volumes of zygomatic bulging differed from control subjects, although all volume differences were small (median < 3.3 ml), temporal hollowing did not differ significantly.Based on our results we conclude that our modified Rubin temporalis transposition technique provides an elegant way to conceal bulging over the zygomatic arch and prevents temporal hollowing, without the need for fascial extensions to reach the modiolus.