Muscle Transposition for Facial Reanimation: Indications and Results

Temporalis muscle transposition was used as an effective technique to reanimate the paralyzed face. It was employed under the following general conditions: (1) the peripheral facial neuromuscular system was unsuitable; (2) the central stump was not available for grafting and the patient elected not to have another cranial nerve sacrificed; (3) the hypoglossal-facial anastomosis was contraindicated; and (4) unsatisfactory results were achieved with grafting or following a hypoglossal-facial anastomosis. The technique described by Rubin and Baker and Conley has been modified to achieve reproducible, reliable, and satisfying results. The main modifications include (1) muscle lengthening with attached periosteum; (2) attaching muscle to the mucous membrane-mucocutaneous junction of the upper lip; (3) creating a wide cheek tunnel to allow the temporalis muscle to lie flat, which minimizes the bulge in the cheek region; and (4) implanting a Silastic block only in selected cases.