Outcomes Following Temporalis Tendon Transfer in Irradiated Patients

Figure 1. Method of photographic analysis of a patient from the irradiated group (group R). Patient R7 3 months after temporalis tendon transfer. Her pupils have been manually outlined, and the computer program uses this information to drop a vertical midline. The intersection of this line with the vermiliocutaneous border of the lower lip, and the commissure, are then manually identified. This allows the program to draw and calculate values for triangle sides a, b, and c and angle A, formed with the vertical. Note that angle A measures between c and the midline below the lip; thus, “good” values are usually over 105°.

Figure 2. Preoperative and postoperative photographs of patient 3 from the nonirradiated group (group N). Patient N3 attempting a closed-mouth smile preoperatively (A) and 3 months postoperatively (B). She underwent right facial advancement flap, right lower eyelid tightening with auricular cartilage graft to support the eyelid, right upper eyelid platinum weight placement, right suborbicularis oculi midface-lift, right direct brow-lift, and left lower lip depressor transection. We have found that female patients who begin wearing makeup again postoperatively are the patients that are most pleased with their results.

Figure 3. Comparison of conformal and intensity-modulated radiotherapy (IMRT) to the parotid bed. Comparison of treatment planning for postparotidectomy adjuvant radiotherapy using (A) conformal or (B) IMRT. A, Numbers along isodose lines signify a percentage of the maximum. B, IMRT isodose lines refer to the actual dose delivered to that area. Note how the masticator space receives 54 Gy (90% of 60 Gy) with traditional radiotherapy but only 35 to 45 Gy using IMRT.

Figure 4. The importance of angle A, formed with the vertical. Patient N4 from the nonirradiated group (group N) after temporalis tendon transfer at rest (A) and smiling (B). The patient is able to produce an acceptable and recognizable smile postoperatively, despite a small Δ c = 1.6 mm, where c is the long diagonal or hypotenuse of movement. This is due to the large Δ A = 20.1°.