Functional outcome comparison of lengthening temporalis myoplasty and free gracilis muscle transfer in children with facial palsy
Kristin Faschan, M.D., Daniel Mazzaferro, M.B.A., Scott Bartlett, M.D., Oksana Jackson, M.D., Phuong Nguyen, M.D..
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Background: Lengthening temporalis myoplasty (LTM) and cross-face nerve graft with free gracilis muscle transfer (CFNG-FGMT) are the two most common procedures used to restore dynamic facial animation and improve facial symmetry. There has not been direct comparison or consensus. Here, we compare our experience with respect to muscle activity, and excursion.
Methods: A retrospective review was performed of patients with facial palsy who had CFNG-FGMT or LTM from 2008-2016 at a single institution. Postop surface EMG was recorded at maximum open smile. Normal and paralyzed sides of the face were analyzed with Facial Assessment by Computer Evaluation (FACE-gram) software. Commissure excursion was determined as the difference in commissure position between smile and resting position. Statistical analysis included Wilcoxon rank sum, Fisher exact test, and multi-level mixed-effects regression.
Results: Six patients with LTM and 10 with CFNG-FGMT met inclusion criteria. Muscle activity was first identified in LTM patients after 3 months (47.42±9.55mV, p<0.001) and CFNG-FGMT patients after 3 months (28.30±8.13mV, p<0.001). Beta-coefficient regression demonstrated a faster increase in sEMG in LTM compared to CFNG-FGMT patients (5.74mV/month, p<0.001 vs. 3.22mV/month, p<0.001). Commissure excursion was comparable in both groups after 9-12 months (CFNG-FGMT 6.2 ± 2.3 mm vs. LTM 5.6 ±1.5 mm).
Conclusion: Dynamic facial animation improved in both surgical groups. LTM demonstrates a faster rate of muscle recruitment compared to CFNG-FGMT. After 9-12 months, both LTM and CFNG-FGMT groups had comparable excursions.
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