Facial Reanimation With Minimally Invasive Orthodromic Temporalis Tendon Transposition and Gold Weight Insertion for Paralytic Lagophthalmos Correction

Facial nerve paralysis can be a debilitating condition involving aesthetic and functional deficits not to mention the emotional turmoil. Depending on the nature of injury, outcomes can vary as well as treatment options. Reanimation remains to be a daunting task, and while there are several new and refined reconstructive techniques being offered, there is still no gold standard procedure that will return normal facial nerve function. We present a case of a 43-year-old woman with a 6-year history of hemifacial weakness which she sustained after undergoing total parotidectomy and neck dissection for a left infra-auricular mass. She presented with incomplete closure of the left eye and drooping of the corner of her mouth. Lid loading with gold weight was used to correct the lagophthalmos, and dynamic reconstruction of the oral commissure was achieved using a minimally invasive orthodromic temporalis tendon transfer with a fascial lata graft extension. Postoperatively, the patient reported improvement of her symptoms with acceptable functional and cosmetic result at 2 years of follow-up.