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DOI: 10.1055/s-0041-1731766
Static Suspension of the Paralyzed Face Utilizing the Midfacial Corridor: Anatomic Evaluation and Surgical Technique
Funding None of the authors, nor their close family members, have a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Furthermore, the authors declare that no commercial associations or financial disclosures exist that might pose or create a conflict of interest with information presented in this manuscript.
Abstract
Background Fascia lata and tendon grafts are frequently utilized to support the paralyzed midface and to extend muscular reach in McLaughin style, orthodromic temporalis transfers. The grafts are frequently placed in a deep subcutaneous positioning that can lead to the development of a, bowstring deformity in the cheek. This paper describes insertion of tendon grafts into the midfacial corridor collectively formed by the buccal, submasseteric and superficial temporal spaces.
Methods Over a seven-year period, all patients that underwent insertion of facia lata and tendon grafts in the midfacial corridor were included. Demographic information, perioperative variables and clinical outcomes were collected and analyzed.
Results A total of 22 patients were included with a mean age of 64.3 years (33–86). There were multiple etiologies for the facial weakness including acoustic neuroma (9.1%), Bell's palsy (13.6%), facial nerve schwannoma (9.1%), temporal bone fracture (4.6%) and malignancy (22.7%). Midfacial corridor grafts were utilized in combination with nerve transfers (V-VII and XII-VII) in nine patients, McLaughin style temporalis transfers in 12 and as a standalone procedure in one individual. During the study period, no patients exhibited a tethering, or concave deformity in the midface. Additionally, no impingement, difficulties with mastication, parotitis or hematoma were encountered. One patient developed a postoperative infection, that was successfully managed.
Conclusion Placement of tendon or fascia grafts for static support or tunneling of an orthodromic temporalis transfer through the midfacial corridor can be performed rapidly while providing midfacial support and avoiding the creation of visible cutaneous deformities.
Ethical Considerations
The work described in this manuscript was approved by our institutional review board (IRB approval: 00011704 Observational Research in the Department of Plastic and Reconstructive Surgery). The authors adhered to the Declaration of Helsinki at all time.
Publikationsverlauf
Eingereicht: 11. März 2021
Angenommen: 12. Mai 2021
Artikel online veröffentlicht:
23. August 2021
© 2021. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
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References
- 1 Cavalcanti DD, Preul MC, Kalani MYS, Spetzler RF. Microsurgical anatomy of safe entry zones to the brainstem. J Neurosurg 2016; 124 (05) 1359-1376
- 2 Labbé D, Huault M. Lengthening temporalis myoplasty and lip reanimation. Plast Reconstr Surg 2000; 105 (04) 1289-1297 , discussion 1298
- 3 Boahene KD, Farrag TY, Ishii L, Byrne PJ. Minimally invasive temporalis tendon transposition. Arch Facial Plast Surg 2011; 13 (01) 8-13
- 4 Zhang HM, Yan YP, Qi KM, Wang JQ, Liu ZF. Anatomical structure of the buccal fat pad and its clinical adaptations. Plast Reconstr Surg 2002; 109 (07) 2509-2518 , discussion 2519–2520
- 5 Guidera AK, Dawes PJ, Fong A, Stringer MD. Head and neck fascia and compartments: no space for spaces. Head Neck 2014; 36 (07) 1058-1068
- 6 Stuzin JM, Wagstrom L, Kawamoto HK, Baker TJ, Wolfe SA. The anatomy and clinical applications of the buccal fat pad. Plast Reconstr Surg 1990; 85 (01) 29-37
- 7 Riffat F, Hasan Z, Buchanan M, Vu D, Palme C. A diagnostic and surgical approach to masses of the buccal space: a case series. Aust J Otolaryngol 2019; 2: 1-10
- 8 Parker NP, Eisler LS, Dresner HS, Walsh WE. Orthodromic temporalis tendon transfer: anatomical considerations. Arch Facial Plast Surg 2012; 14 (01) 39-44
- 9 Dorafshar AH, Borsuk DE, Bojovic B. et al. Surface anatomy of the middle division of the facial nerve: Zuker's point. Plast Reconstr Surg 2013; 131 (02) 253-257
- 10 Garcia RM, Hadlock TA, Klebuc MJ, Simpson RL, Zenn MR, Marcus JR. Contemporary solutions for the treatment of facial nerve paralysis. Plast Reconstr Surg 2015; 135 (06) 1025e-1046e
- 11 Yano T, Okazaki M, Yamaguchi K, Akita K. Anatomy of the middle temporal vein: implications for skull-base and craniofacial reconstruction using free flaps. Plast Reconstr Surg 2014; 134 (01) 92e-101e
- 12 Viterbo F, de Paula Faleiros HR. Orthodromic transposition of the temporal muscle for facial paralysis: made easy and better. J Craniofac Surg 2005; 16 (02) 306-309
- 13 Rose EH. Autogenous fascia lata grafts: clinical applications in reanimation of the totally or partially paralyzed face. Plast Reconstr Surg 2005; 116 (01) 20-32 , discussion 33–35
- 14 Kiefer J, Braig D, Thiele JR, Stark GB, Eisenhardt SU. Combination of Static and Dynamic Techniques for Smile Reconstruction in Patients with Flaccid Facial Paralysis. Plast Reconstr Surg Glob Open 2019; 7 (07) e2322
- 15 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 (01) 63-70
- 16 Puddu A, Tuinder S, Qiu SS, Regali E, Salimbeni G. Abstract: 15.20 Revisited Fascia Lata In Facial Palsy. Plast Reconstr Surg Glob Open 2017; DOI: 10.1097/01.GOX.0000512428.78423.26.