Lengthening Temporalis Myoplasty for Facial Paralysis Reanimation

Facial paralysis is not merely an aesthetic problem; it is a serious neuromuscular condition that directly affects fundamental functions such as speech, chewing, eye protection, and most importantly, facial expressions. Especially in cases of prolonged and persistent peripheral facial paralysis, surgical reanimation methods become relevant when the likelihood of spontaneous recovery decreases. At this point, temporalis muscle lengthening myoplasty stands out as a powerful and reliable option among dynamic facial reanimation techniques. If you would like detailed information about this procedure, you can take a detailed look at our content. We wish you all good reading and healthy days.

The Importance of Dynamic Resuscitation in Facial Paralysis

The importance of dynamic reanimation in facial paralysis stems from the fact that it aims not only to correct facial symmetry but also to restore mimic movements. In this context, while static methods can improve the appearance of the face at rest, they cannot restore active functions such as smiling, speaking, blinking, and expressing emotions. However, the face is the most fundamental tool of social communication, and the loss of emotional expression has serious functional and psychosocial effects on patients.

Dynamic reanimation aims to create mobile and controlled facial expressions by providing active motor stimulation to the muscles through nerve transfers, muscle transfers, or muscle redirection techniques. This supports not only aesthetic balance but also vital functions such as oral competence (mouth closure strength), articulation, and eye protection. Especially in cases of long-term peripheral facial paralysis, dynamic reanimation, when applied with proper timing and appropriate technique selection, is a fundamental treatment approach that increases the patient's social confidence, restores facial expression, and significantly improves quality of life.

What is Temporalis Muscle Lengthening Myoplasty?

Temporalis muscle lengthening myoplasty is a surgical facial reanimation technique used to restore dynamic smiling function in cases of long-term peripheral facial paralysis. In this technique, the powerful temporalis muscle, located in the temple region and normally involved in chewing function, is surgically released and directed toward the corner of the mouth using special lengthening techniques (such as tendon advancement or fascia grafting) and then fixed in place. The goal is to compensate for the dysfunction of the paralyzed facial muscles with the strength of a healthy, active muscle. In this context, when the patient chews, the temporalis muscle contracts, pulling the corner of the mouth upward and creating a dynamic smile. It is preferred as an effective alternative, especially in patients with advanced atrophy in the facial muscles and those who have missed the appropriate time window for nerve transfer. With proper planning and appropriate vector adjustment, both facial symmetry can be improved and functional facial expression can be achieved.

How is the Temporalis Muscle Lengthening Myoplasty Procedure Performed?

Since temporalis muscle lengthening myoplasty is a dynamic reanimation procedure performed after detailed facial analysis and surgical planning, the patient's facial symmetry, the current position of the corner of the mouth, and the targeted smile vector are first determined. Then, during surgery, the temporalis muscle is carefully exposed through an incision made in the scalp or temple area and freed while preserving the underlying structures. Thus, the lower part of the muscle or its tendinous extension is mobilized; in necessary cases, fascia grafting or tendon lengthening techniques are used to increase the length of the muscle. This extended muscle structure is then fixed to the corner of the mouth (modiolus region) with appropriate tension and in the correct direction of pull. The main goal here is to ensure that the corner of the mouth moves upward and slightly outward in a natural smile line when the muscle contracts. After the surgery, the patient initially learns to activate the smile with chewing movements, and over time, with the support of physical therapy, this movement becomes more coordinated and controlled.

Who is Eligible for Temporalis Muscle Lengthening Myoplasty?

Temporalis muscle lengthening myoplasty (or temporalis muscle transfer) is a reanimation method generally used to restore the ability to smile and mouth corner mobility after permanent facial paralysis (facial paralysis). Suitable candidates for this procedure are generally as follows:

• Patients with Permanent Facial Paralysis
• Those Who Have Lost the Ability to Smile
• Those Who Are Not Suitable for Microsurgery
• Those With an Intact Temporalis Muscle
• Those Who Have Undergone Unsuccessful Nerve Repair
• Those Expecting a Shorter Recovery Period
• Those With a History of Radiotherapy

We can say that you are a suitable candidate for the temporalis muscle lengthening myoplasty procedure. However, to obtain clearer and more detailed information on this matter, you can contact Dr. Be to find out whether you are the right candidate for temporalis muscle lengthening myoplasty.

Advantages of Temporalis Muscle Lengthening Myoplasty

The temporalis muscle lengthening myoplasty (TUM) procedure offers numerous strategic advantages for both the surgeon and the patient, particularly in facial paralysis rehabilitation (restoring movement). These advantages include:

• Rapid Functional Results: While micro-surgical techniques using nerve grafts require waiting months (6-12 months) for nerve regrowth, this method involves directly attaching the muscle to the corner of the mouth, allowing movement to begin within a few months with physical therapy.
• Short Surgery Time: While microsurgical procedures such as free muscle transfer can take 8-12 hours, temporalis myoplasty is usually completed within 2-3 hours. This reduces the risk of general anesthesia.
• Single-Session Procedure: While many nerve repair methods require two-stage surgery, this procedure corrects resting facial symmetry and initiates smiling function in a single operation.
• No Microsurgery Required: Since it does not require vascular and nerve suturing (microvascular anastomosis), it is considered technically safer and can be successfully applied even in patients with unsuitable vascular structures.
• Low Morbidity (Side Effects): Since muscle tissue is not taken from another part of the body (such as the leg or back), there is no scarring or loss of function in another area.
• Corrects Resting Asymmetry: It lifts the drooping corner of the mouth not only during movement but also when the face is motionless, giving the face a more symmetrical appearance.
• Suitable for a Wider Age Range: It is the safest dynamic method for elderly patients who cannot tolerate long surgery times or individuals with sensitive general health conditions.
• Adaptation with Natural Chewing Reflex: Initially, the patient learns to smile by clenching their teeth, but over time, the brain can automate this movement (brain plasticity) to create a more natural smile.
• Invisible Scarring: Since surgical incisions are typically made within the scalp or inside the mouth, no noticeable surgical scar remains on the external part of the face.

Pre- and Post-Operative Considerations for Temporalis Muscle Lengthening Myoplasty

There are many points to consider before and after temporalis muscle lengthening myoplasty. Paying attention to all these points facilitates a smoother and more comfortable surgical process, while also promoting rapid recovery after surgery. Therefore, it is essential to follow the doctor's advice and warnings after the procedure.

Pre-Temporalis Muscle Lengthening Myoplasty Considerations

There are certain key points to consider before undergoing a temporalis muscle lengthening myoplasty procedure. These points help ensure you are fully prepared for the treatment. Therefore, the following warnings must be taken into account.

• At least 7-10 days before surgery, blood thinners (aspirin, warfarin, etc.), herbal supplements (Ginkgo biloba, vitamin E), and omega-3 should be discontinued under a doctor's supervision.
• Smoking impairs tissue nutrition, delays wound healing, and increases the risk of infection.
• Therefore, it is essential to quit smoking at least 3-4 weeks before surgery.
• Since part of the surgery is performed inside the mouth (intraoral), there should be no active infection or decayed teeth in the mouth. If necessary, dental cleaning should be performed before the operation.
• Any imaging studies requested by your surgeon, such as an MRI or CT scan, to examine the current state of the facial muscles and the structure of the temporalis muscle must be completed in full.
• This surgery does not produce a “spontaneous” (natural) smile, but rather a “voluntary” smile.
• The patient must be informed that they will need to learn to clench their teeth in order to smile and must be prepared for this.
• Prior information should be obtained about the exercises that will be performed after the surgery to help the muscle adapt to its new function, and if possible, a preliminary consultation with a rehabilitation specialist should be arranged.
• Since the incision is usually made within the scalp, the hair should be washed with antiseptic shampoo on the day of the surgery or the day before, but the hair should not be shaved (the surgeon will prepare the necessary area during the operation).
• If the patient has chronic conditions such as diabetes or high blood pressure, these values should be stabilized before the surgery.
• Nothing, including water, should be consumed after midnight on the night before the operation to ensure a completely empty stomach.

Precautions to Take After Temporalis Muscle Lengthening Myoplasty

After undergoing a temporalis muscle lengthening myoplasty operation, great care must be taken to achieve positive results. This allows for a faster recovery process and quicker healing of post-operative scars.

• Keeping the head elevated at a 30-45 degree angle (using two pillows) after surgery minimizes swelling and edema in the face. Avoid strenuous physical activity for the first two days.
• To protect the stitches where the muscle is attached to the corner of the mouth, only soft foods (soup, puree, yogurt, etc.) should be consumed for the first 2-3 weeks. Avoid hard chewing motions and large bites.
• Since part of the surgery is performed inside the mouth, rinse your mouth with the antiseptic mouthwash recommended by your doctor after every meal. This prevents infection along the suture line.
• Applying ice compresses intermittently (15 minutes on, 15 minutes off) to the surgical area for the first 24-48 hours reduces swelling and bruising. Care should be taken to ensure that the ice does not come into direct contact with the skin.
• For the first 15 days, avoid strenuous movements such as excessive laughing, yawning, or opening the mouth very wide. It is important to remain “calm” during this period to allow the muscle to integrate with the tissue in its new location.
• With the surgeon's approval (usually starting from the 2nd or 3rd week), exercises are begun in front of a mirror. Exercises involving clenching the teeth to lift the corners of the mouth help the brain recognize this muscle as the “smile muscle.”
• Do not play with the stitches in the scalp and inside the mouth. Hair washing can usually be done from the 3rd day onwards with special shampoos recommended by the doctor, without irritating the stitch line.
• To prevent the incision marks on the face from becoming permanent and changing color, a high-factor sunscreen should be used for at least 6 months and direct sunlight should be avoided.
• The surgeon's specified follow-up schedule (1 week, 1 month, 3 months, etc.) should be strictly adhered to in order to monitor muscle tension and mobility.

If you would like detailed information about the temporalis muscle lengthening myoplasty procedure, you can contact Dr. Berke Özücer and his team, who specialize in facial paralysis.