If you have wondered about a surgery that could restore your smile and improve your self-confidence after facial paralysis, then you have probably heard about the temporalis tendon transfer procedure. The temporalis tendon transfer procedure is an old procedure described over 50 years ago for restoring movement to the paralyzed face. We recently modified the old technique making it more effective and performing it in a minimally invasive manner.
Understanding how this technique works in restoring facial movement is very important for anyone considering this procedure as success depends greatly on both the technically aspects of the surgery and the input from patients. Teamwork between the surgeon and patient is crucial.
There are 6 pairs of major facial muscles involved in smiling. These muscles move the lips in a coordinated fashion to create the different types of smile we know. When the facial nerve, for any reason (Bell’s palsy, tumor, trauma) becomes injured, proper function of the facial muscles is affected and movement is disrupted. The muscles of the face depend on constant information from the facial nerve to stay alive. When deprived of complete nerve input for a prolonged period, the facial muscles shrink and scar. Resurrecting a scarred muscle is impossible. It is therefore important that nerve input into paralyzed facial muscles be restored as soon as possible.
When it is determined that restoring nerve input to a paralyzed face in not possible, then transferring a functional muscle from other sources to the face becomes a viable option. The practice of transferring a muscle tendon to restore a lost muscle function is commonly practiced in hand surgery. For example, if someone sustain a crush injury of the arm where there muscle that moves the thumb is complete avulsed and totally lost, thumb function, being important in maintaining a grip, may be restored by moving muscle and tendon from one of the other fingers and connecting it to the thumb bones. The temporalis tendon transfer procedure works in a similar fashion. In its normal location, the temporalis muscle is a fan shaped muscle that connects to the jaw joints and aids in jaw movement. There are other muscles of the jaw that can compensate well for the temporalis muscle. Thus, one can borrow the function of the temporalis muscle to reproduce the lost function of the paralyzed facial muscle.
In the temporalis tendon transfer procedure, we disconnect the tendon from its attachment and stretch it to connect to the corner of the mouth. In some individuals, the tendon is long enough to reach the corner of the mouth. In other individuals the tendon is not long enough and a tendon extender may be required. We have developed various techniques that we employ to determine where to connect the tendons and how much tension to use to achieve the best result. Personally, this is one of the most rewarding reconstructive procedures I perform. To see someone’s face move in surgery, when it has been paralyzed for years literally put a smile on my face.
But this technical feat is not the whole story. Our brains are mapped at birth and developed over time such that various functions can be traced to specific areas on the brain. While the facial muscles are mapped to a specific site, the temporalis muscle is mapped to a different spot. Retraining the brain to refocus the power of the temporalis muscle from jaw movement to facial movement for smiling requires a dedicated effort of repetition and practice. Using biofeedback techniques are helpful.
It is important to understand the limitations of the temporalis tendon transfer procedure. As noted earlier, there are about 6 pairs of major muscles need for a smile. The transferred temporalis muscle can replicate the movement of only one of these muscles, howbeit the most important, the zygomaticus muscle. Therefore a full broad smile may sometimes not be possible. Nevertheless the facial movement gain from the temporalis muscle often masks the absence of the other muscle movements. In addition, the exaggerated movement from the non paralyzed side that distorts the face into a grimace is fully corrected.
When properly performed, the temporalis tendon transfer procedure has the potential of restoring facial movement even in patients who have had their paralysis for their entire live.
Visit us at www.drboahene.com to learn more about facial paralysis and your treatment options.