14 DAY TRIAL // A minimally invasive technique which brings no major modifications to bone, can be used to transfer a tendon and help reanimate the lower face after paralysis, a newly published report concluded.
This is a procedure that has been used before, but which now only involves a small incision, instead of the common section at the temple and surgical dissection of the temporalis muscle.
As background information in the published article, the authors write that “the primary goal of all facial reanimation protocols is to restore facial movement that is controlled, symmetrical and spontaneous.”
Of course, even if this new technique is minimally invasive, patients still need to go through directed physical therapy and must be extremely motivated in order to succeed.
The previous, more invasive method consisted in transferring the temporalis tendon, which is attached to the temporalis muscle (a large fan-shaped muscle on the side of the head), in order to reanimate the face.
But now, Kofi D. Boahene, MD, and colleagues at the Johns Hopkins University School of Medicine, Baltimore, reported a series of 17 consecutive patients suffering from facial paralysis, who between 2006 and 2008, underwent a minimally invasive temporalis tendon transposition procedure.
For this new technique, a small incision suffices, and the tendon is accessed through the skin folds on the side of the nose or through the mouth.
The authors write that “all the patients tolerated the procedure well, and none developed procedure-related complications.
“All the patients achieved improved symmetry at rest and voluntary motion of the oral commissure [corners of the mouth].”
Even though this is a revolutionary approach, miracles do not happen over night, and the authors say that “the visible movement gained from dynamic muscle transposition does not translate into a spontaneous controlled smile without intensive neuromuscular retraining.”
Apparently, all patients must learn the 'Mona Lisa' smile first, when only the corners of the mouth are slightly elevated, but the lips do not move.
Then, they can learn to smile by contracting the temporal muscle without moving the jaw.
“Dynamic reanimation after facial paralysis remains challenging but can be achieved in selected patients using the minimally invasive temporalis tendon transposition (MIT3)” say the authors.
“Although the technique is straightforward and dynamic movement can be demonstrated with intraoperative muscle stimulation, acquisition of desired facial movement requires intensive physiotherapy and a motivated patient.”
This report appears in the January/February issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.