Keeping the fat on the right spot prevents contour deformity in temporalis muscle transposition.

Autor: van Veen MM; Department of Plastic Surgery, University of Groningen and University Medical Centre Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands. Electronic address: m.m.van.veen@umcg.nl., Korteweg SFS; Bergman Clinics, Willemsparkweg 151, 1071 GX, Amsterdam, The Netherlands., Dijkstra PU; Centre for Rehabilitation and Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Centre Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands., Werker PMN; Department of Plastic Surgery, University of Groningen and University Medical Centre Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
Jazyk: angličtina
Zdroj: Journal of plastic, reconstructive & aesthetic surgery : JPRAS [J Plast Reconstr Aesthet Surg] 2018 Aug; Vol. 71 (8), pp. 1181-1187. Date of Electronic Publication: 2018 Apr 13.
DOI: 10.1016/j.bjps.2018.04.007
Abstrakt: The temporalis muscle transposition is a reliable, one-stage reanimation technique for longstanding facial paralysis. In the variation described by Rubin, the muscle is released from the temporal bone and folded over the zygomatic arch towards the modiolus. This results in unsightly temporal hollowing and zygomatic bulging. We present a modification of this technique, which preserves the temporal fat pad in its anatomical location as well as conceals temporal hollowing and prevents zygomatic bulging.  The data of 23 patients treated with this modification were analysed. May classification was used for evaluation of mouth reanimation. Experts and patients scored visibility of the contour deformity on a 100-mm visual analogue scale (VAS) (score 0 = poor/100 = best). 3D images of the face were used to measure temporal hollowing and zygomatic bulging. 3D images were compared to those of controls with a similar gender and age distribution.  After a median follow-up of 5.7 years, all patients achieved symmetry at rest. Eleven patients achieved symmetry while smiling with closed lips (May classification "Good"). A median (interquartile range [IQR]) VAS score of 19 (6; 41) was given by experts and 25 (5; 59) by patients themselves. 3D volumes of zygomatic bulging differed from those of control subjects, although all volume differences were small (median <3.3 ml) and temporal hollowing did not differ significantly. On the basis of our results, we conclude that our modified Rubin temporalis transposition technique provides an elegant way to conceal bulging over the zygomatic arch and prevents temporal hollowing, without the need for fascial extensions to reach the modiolus.
(Copyright © 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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