Smile Reconstruction for Patients with Congenital Incomplete Facial Paralysis using Modified Lengthening Temporalis Myoplasty.

[OBJECTIVES] Treatment of congenital facial paralysis is often postponed because patients exhibit only mild dysfunction and inconspicuous facial asymmetry at rest. Surgical facilitation of smiling has significant implications for the quality of life and the physical and mental development of patients. We describe facial reanimation using modified lengthening temporalis myoplasty (LTM) in patients with congenital incomplete facial nerve palsy who first presented to our institution after the age of 10 years.

[METHODS] Three patients (age, 12-26 years; two males and one female) underwent facial reanimation with modified LTM using an extended S-shaped incision. In two cases, T-shaped fascial grafts were simultaneously applied to the lower lip. Evaluation was conducted using a simple and objective method to assess smile symmetry.

[RESULTS] The postoperative follow-up period ranged from one to nine years. Postoperatively, the oral commissure remained symmetrical at rest in all three cases. Good symmetry was observed during voluntary smiling in all three cases and during spontaneous smiling in two cases.

[CONCLUSIONS] Modified LTM, a technique that does not require microsurgery and leaves no facial scarring, is a useful option for smile reconstruction in patients with congenital incomplete facial nerve paralysis.