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.
Keywords
facial paralysis - fascial graft - buccal fat pad - lengthening temporalis myoplasty
