Abstract
Objective: 1) Understand the relationship of anatomic structures at risk for injury during the transfacial orthodromic temporalis tendon transfer procedure (OTTT) for facial reanimation. 2) Define the anatomic limitations of the OTTT without temporal releasing incisions of the muscle origin or perioral lengthening materials.
Method: Ten fresh cadavers were used to perform 20 hemi-face dissections. Detailed measurements and photographic documentation examined the parotid duct (PD), masseteric artery (MA), inferior alveolar nerve (IAN), and internal maxillary artery (IMA) relative to surgical landmarks. The perioral reach of the mobilized temporalis tendon was measured and photographically documented.
Results: Measurements revealed a consistent relationship between the PD and a reproducible reference line. The PD was located within the superior dissection field in all dissections. The IAN was consistently located over a centimeter from the TT insertion on the medial mandible and from the anterior ascending ramus. The MA consistently coursed within millimeters of the most inferior portion of the sigmoid notch within the substance of the masseter muscle. The IMA consistently coursed superiorly from posterior to anterior just medial to the mandible. All tendons (100%) reached beyond the melolabial crease to the perioral musculature for orthodromic resuspension.
Conclusion: Reproducible PD-reference line measurements allow for pre-incision PD localization. Consistent relationships between the tendon, PD, neurovascular structures, and bony landmarks underscore that deliberate soft tissue retraction and subperiostial elevation minimizes injury risk. The mobilized tendon appears to achieve adequate length for resuspension without temporal releasing incisions or perioral lengthening materials.
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