Gracilis Free Muscle Transfer versus Lengthening Temporalis Myoplasty for Lip Reanimation
Mark Urata, DDS, MD, Andre Panossian, MD.
Children's Hospital Los Angeles, Los Angeles, CA, USA.
The gold standard for dynamic lip reanimation in facial paralysis is the free gracilis flap. The lengthening temporalis myoplasty (LTM) promises greater predictability, shorter operative times, and decreased hospital stay. No studies have shown an advantage of one procedure over another.
From 2008 to 2014, 31 patients underwent lip reanimation for facial paralysis. Nineteen underwent free gracilis transfers, and 12 underwent LTM. A retrospective chart review assessed demographics, procedure type, diagnosis, and laterality. Patient and surgical variables collected included operative times, hospital length of stay, and perioperative complications.
Eight patients required bilateral reconstruction. There were 2 revisions in the gracilis group (flap loss) and 6 in the LTM group. Average operative time was 545 minutes for gracilis transfers, and 416 minutes for LTM (p<0.001). Average length of stay was 4.8 days for gracilis, and 3.4 days for LTM (p>0.01). All gracilis patients required overnight ICU admission; no LTM patients required ICU. Complications included four cheek infections for gracilis group and one in LTM group. Inadequate oral commissure excursion was the reason for revision in four LTM patients.
Lengthening temporalis myoplasty is a safe alternative to free tissue transfer for lip reanimation. Benefits to this procedure include limited donor site morbidity and immediate, predictable improvements in facial appearance. Shorter operative times, avoidance of ICU stays, and shorter hospital overall stays are financially favorable. Revision rate for LTM appears to be high, but does not result in increased length of stay.
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