Lengthening temporalis myoplasty versus free muscle transfer with the gracilis flap for long-standing facial paralysis: A systematic review of outcomes.

BACKGROUND: Our aim was to compare the outcomes of reconstructive surgery for long-standing facial paralysis by gracilis free flap transfer versus lengthening temporalis myoplasty (LTM) according to Daniel Labbé.

MATERIALS AND METHODS: PubMed, Web of Science, Wiley Online Library, Cochrane Library, Directory of Open Access Journals, and SAGE Premier 2011 database were electronically searched. Randomized controlled trials (RCTs), controlled clinical trials (CCTs), and case series with a sample size > 5 were sought. Data were extracted by a single investigator.

RESULTS: Sixteen articles met the selection criteria. All of these studies were retrospective case series. Efficacy outcomes were analyzed by assessing mouth symmetry both at rest and upon smiling, as well as the quality and the spontaneanity of the smile. Commissural displacement in patients operated by the gracilis flap was greater after surgery involving masseteric nerve reinnervation than a cross-facial nerve graft reinnervation. Patients with double innervation had similar results to those who had surgery involving only masseteric nerve reinnervation. These results are in accordance with the subjective evaluations. Patients operated by the lengthening temporalis myoplasty achieve less lateral movement of the commissure, with controversial evidence of spontaneity (only "automatic").

CONCLUSIONS: There are currently no published RCTs or CCTs regarding facial reanimation surgery. Thus, only very weak evidence is available to support the use of one type of surgery over another. However, our review suggests that LTM achieves results that are at least equal to those obtained with gracilis transfer, but LTM is a less extensive procedure that provides quicker results without the need for more than one operation. LTM, therefore, seems a good alternative to free muscle flap.

LEVEL OF EVIDENCE: IV.