Temporalis Muscle Transposition in Irreversible Facial Nerve Palsy: A Vestibular Approach

Background The facial nerve plays a crucial role in innervating the motor supply of facial muscles, enabling essential facial expressions that facilitate human communication. Defects or damages to this nerve can have significant consequences, leading to functional, emotional, and social difficulties caused by the immobility of facial muscles. Patients suffering from irreversible facial nerve palsy often experience functional symptoms such as eyelid closure defects, mouth deviation, and limited movement. Methods This study aims to address these challenges and offer potential solutions for patients with irreversible facial nerve palsy. In this study, 18 patients (three males and 15 females) underwent temporalis transfer with an intraoral approach in the cranio-orbito-palpebral unity. Preoperative facial reanimation planning involved evaluating the smile's appearance on the unaffected side. Photographs were captured in various positions, and facial expressions were examined. Following this, botulinum toxin was injected into the normal side of the face seven days before the procedure to address the hyperactive condition of the mimic muscles. Results Temporalis transfer with an intraoral approach for oral commissure reanimation in the context of irreversible facial nerve palsy was performed. The surgical procedure combined coronal and orbital approaches and achieved the desired outcomes. Postoperative complications observed included hematomas and ossification. Functional outcomes, assessed using the House-Brackmann grading system, indicated a mean improvement of 2.5, signifying moderate dysfunction with normal tone and facial symmetry. Conclusion This intervention represents an alternative approach to actual techniques of facial palsy reanimation, especially in selected patients who can benefit from the absence of visible scars, such as young patients and those prone to hypertrophic and keloid scarring, as well as patients with non-prominent nasolabial folds.