The Mini-Temporalis Flap – Useful Adjunct in Facial Reanimation Surgery

Introduction:

Facial nerve paralysis can carry great physical and physiological morbidity for those patients who develop a permanent deficit.  Techniques for improving facial asymmetry following facial nerve paralysis are varied both in terms of functional improvement and levels of risk associated with the procedure.  The mini-temporalis flap has its benefits in reanimating the upper lip in that it does not carry the same morbidity as a free flap procedure.

Method:

This retrospective case note review looked at patients treated by the senior author over a 4 year period (2010-2014) who underwent a mini temporalis transfer procedure.  Data collected included previous procedures, operative time, length of hospital stay and any complications.  Independent physicians then analyzed the pre and post surgery standardized videos according to Sunnybrook and Terzis’s scales.

Results:

24 patients were identified, fifteen women and nine men with a mean age of 60.6 (range 35-94).  Fourteen patients had had some form of surgery to correct the brow and eyelids at the same operation with the mini-temporalis transfer.  Mean operative time was 165 minutes (range 99- 210 minutes).  Average length of hospital stay was 3.9 days.  The complication rate was 8.3% (one haematoma, and one infection requiring surgical intervention). The pre and post surgical evaluation  revealed an overall improvement in both scales.

Conclusion:

The mini-temporalis is a safe and relatively quick one-stage procedure that has demonstrable improvement in upper lip symmetry.  It should be considered in patients who cannot tolerate a multi-staged procedure or those who need augmentation of existing function.