Non-Cochrane · intervention · PM41927316
Smile Asymmetry and Eyelid Closure Following Temporalis Muscle Transfer for Facial Reanimation: A Systematic Review and Meta-Analysis.
Namavarian Amirpouyan, Chung Jonathan M, Sunba Saud, et al. · The Laryngoscope · 2026 · PubMed · doi:10.1002/lary.70527
Findings
Population Patients with facial nerve paralysis
26 findings
| Temporalis muscle transfer | Preoperative baseline | Smile asymmetry reduction Latest follow-up · Surgical | MD 9.611 [7.161, 12.061] GRADE not reported 8 studies · 150 participants |
| Temporalis muscle transfer (TMT) | None (single-arm count) | Flap failure | Count (patients) 3 GRADE not reported Studies not reported |
| Temporalis muscle transfer (TMT) | None (single-arm count) | Implant extrusion | Count (patients) 9 GRADE not reported Studies not reported |
| Temporalis muscle transfer (TMT) | None (single-arm count) | Tendon dehiscence | Count (patients) 2 GRADE not reported Studies not reported |
| Temporalis muscle transfer | Preoperative baseline | Smile asymmetry reduction Latest follow-up · Surgical · Six studies with technique data (minimally invasive and traditional combined) | MD 8.933 [6.749, 11.117] GRADE not reported 6 studies · 94 participants |
| Temporalis muscle transfer | Preoperative baseline | Lagophthalmos reduction 12 months follow-up · Surgical | MD 5.624 [4.714, 6.534] GRADE not reported 6 studies · 182 participants |
| Temporalis muscle transfer | Preoperative baseline | Lagophthalmos reduction 12 months follow-up · Surgical · Studies published after 2010 | MD 6.344 [5.403, 7.284] GRADE not reported 3 studies · 99 participants |
| Temporalis muscle transfer (TMT) | None (single-arm count) | Any complication | Count (patients) 161 GRADE not reported Studies not reported |
| Temporalis muscle transfer | Preoperative baseline | Oral commissure displacement improvement Latest follow-up · Surgical | MD 7.299 [5.916, 8.682] GRADE not reported 5 studies · 90 participants |
| Temporalis muscle transfer (TMT) | None (single-arm count) | Incorrect insertion | Count (patients) 2 GRADE not reported Studies not reported |
| Temporalis muscle transfer (TMT) | None (single-arm count) | Temporal hollowing or depression | Count (patients) 16 GRADE not reported Studies not reported |
| Temporalis muscle transfer (TMT) | None (single-arm count) | Alopecia | Count (patients) 4 GRADE not reported Studies not reported |
| Temporalis muscle transfer (TMT) | None (single-arm count) | Eyelid deformity or ectropion | Count (patients) 16 GRADE not reported Studies not reported |
| Temporalis muscle transfer | Preoperative baseline | Lagophthalmos reduction 12 months follow-up · Surgical · Studies published before 2010 | MD 4.701 [3.803, 5.600] GRADE not reported 3 studies · 83 participants |
| Minimally invasive intra-oral orthodromic temporalis muscle transfer | Preoperative baseline | Smile asymmetry reduction Latest follow-up · Surgical · Minimally invasive intra-oral approach | MD 7.861 [4.378, 11.344] GRADE not reported 3 studies · 51 participants |
| Traditional orthodromic temporalis muscle transfer | Preoperative baseline | Smile asymmetry reduction Latest follow-up · Surgical · Traditional orthodromic approach | MD 9.910 [7.336, 12.484] GRADE not reported 3 studies · 43 participants |
| Temporalis muscle transfer | None (single-arm proportion) | Clinician-graded eyelid closure: partial Latest follow-up · Surgical | Proportion (%) 32 GRADE not reported 387 participants |
| Temporalis muscle transfer | None (single-arm proportion) | Clinician-graded smile: excellent or good (smiling with or without teeth) Latest follow-up · Surgical | Proportion (%) 71 GRADE not reported Studies not reported |
| Temporalis muscle transfer | None (single-arm proportion) | Clinician-graded eyelid closure: complete Latest follow-up · Surgical | Proportion (%) 56 GRADE not reported 387 participants |
| Temporalis muscle transfer | None (single-arm proportion) | Complication: aesthetic deformity Latest follow-up · Surgical | Proportion (%) 3.3 GRADE not reported Studies not reported |
| Temporalis muscle transfer | None (single-arm proportion) | Complication: hematoma, seroma or hemorrhage Latest follow-up · Surgical | Proportion (%) 1.6 GRADE not reported Studies not reported |
| Temporalis muscle transfer | None (single-arm proportion) | Clinician-graded smile: minimal postoperative change Latest follow-up · Surgical | Proportion (%) 5 GRADE not reported Studies not reported |
| Temporalis muscle transfer | None (single-arm proportion) | Complication: flap complication Latest follow-up · Surgical | Proportion (%) 1.6 GRADE not reported Studies not reported |
| Temporalis muscle transfer | None (single-arm proportion) | Complication: infection Latest follow-up · Surgical | Proportion (%) 3.7 GRADE not reported Studies not reported |
| Temporalis muscle transfer | None (single-arm proportion) | Clinician-graded smile: symmetry at rest Latest follow-up · Surgical | Proportion (%) 24 GRADE not reported Studies not reported |
| Temporalis muscle transfer | None (single-arm proportion) | Clinician-graded eyelid closure: no meaningful change Latest follow-up · Surgical | Proportion (%) 12 GRADE not reported Studies not reported |
Included primary studies 53
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Andrews 2015 A prospective 4-year study of the objective and subjective outcomes of fifteen patients after dynamic facial reanimation surgery. PMID:26506507 | 2016 | this review only | Oral commissure displacement improvement | not extracted yet |
| Aum 2013 Orthodromic transfer of the temporalis muscle in incomplete facial nerve palsy. PMID:23898430 | 2013 | this review only | not stated | not extracted yet |
| Balaji 2002 A modified temporalis transfer in facial reanimation. PMID:12521312 | 2002 | this review only | not stated | not extracted yet |
| Biglioli 2018 Mixed facial reanimation technique to treat paralysis in medium-term cases. PMID:29625866 | 2018 | this review only | not stated | not extracted yet |
| Breidahl 1996 A modified surgical technique for temporalis transfer. PMID:8705102 | 1996 | this review only | not stated | not extracted yet |
| Brennan 2024 Immediate lengthening temporalis myoplasty for facial palsy reconstruction following facial nerve inclusive total parotidectomy. PMID:38395687 | 2024 | this review only | not stated | not extracted yet |
| Bussu 2025 The Role of Lengthening Temporalis Myoplasty in the Management of Facial Paralysis: Evaluating Patient-Reported Quality of Life… PMID:40690242 | 2025 | this review only | not stated | not extracted yet |
| Chandrasekaran 2020 M-Mode Echomyography of Facial Muscle Function Following Facial Reanimation with Temporalis Muscle Galea Pedicled Flap: Analysis of Ten… PMID:33071505 | 2020 | this review only | not stated | not extracted yet |
| Chen 2015 Mini-temporalis transposition: a less invasive procedure of smile restoration for long-standing incomplete facial paralysis. PMID:25759922 | 2015 | this review only | not stated | not extracted yet |
| Croxson 2000 Temporalis muscle transfer for facial paralysis: a further refinement. PMID:11460301 | 2000 | this review only | not stated | not extracted yet |
| Das 2011 Efficacy of temporalis muscle transfer for correction of lagophthalmos in leprosy. PMID:22125936 | 2011 | this review only | Lagophthalmos reduction | not extracted yet |
| Ederer 2023 Gender-Specific Evaluation Following McLaughlin’s Dynamic Muscle Support for Irreversible Facial Paralysis DOI:10.3390/sym15020561 | 2023 | this review only | not stated | not extracted yet |
| Elbarbary 2010 Revisiting orthodromic temporalis transfer in treating long-standing facial paralysis. PMID:22110814 | 2010 | this review only | not stated | not extracted yet |
| Fabiana 2022 Minimally invasive temporalis tendon transposition and upper lid lipofilling for immediate and secondary facial reanimation in patients… PMID:35292202 | 2022 | this review only | not stated | not extracted yet |
| Foirest 2017 Smile Reanimation after Unilateral Facial Palsy by Lengthening Temporalis Myoplasty: Objective and Subjective Evaluation on 25 Cases. PMID:28002243 | 2017 | this review only | Smile asymmetry reduction; Oral commissure displacement improvement | not extracted yet |
| Frey 2004 Dynamic reconstruction of eye closure by muscle transposition or functional muscle transplantation in facial palsy. PMID:15468391 | 2004 | this review only | Lagophthalmos reduction | not extracted yet |
| Gousheh 2011 Treatment of facial paralysis: dynamic reanimation of spontaneous facial expression-apropos of 655 patients. PMID:21841532 | 2011 | this review only | not stated | not extracted yet |
| Griffin 2012 Outcomes following temporalis tendon transfer in irradiated patients. PMID:22710650 | 2012 | this review only | Smile asymmetry reduction; Oral commissure displacement improvement | not extracted yet |
| Gupta 2014 Modified silicone sling assisted temporalis muscle transfer in the management of lagophthalmos. PMID:24618488 | 2014 | this review only | Lagophthalmos reduction | not extracted yet |
| Har‐Shai 2010 Intraoperative muscle electrical stimulation for accurate positioning of the temporalis muscle tendon during dynamic, one-stage… PMID:20595862 | 2010 | this review only | not stated | not extracted yet |
| Hayashi 2022 Modified Lengthening Temporalis Myoplasty Using an Intraoral Approach. PMID:35727673 | 2022 | this review only | Smile asymmetry reduction | not extracted yet |
| Holtmann 2017 Outcome of a graduated minimally invasive facial reanimation in patients with facial paralysis. PMID:28391532 | 2017 | this review only | not stated | not extracted yet |
| House 2021 Temporalis Tendon Transfer/Lengthening Temporalis Myoplasty for Midfacial Static and Dynamic Reanimation After Head and Neck Oncologic… PMID:32486859 | 2021 | this review only | not stated | not extracted yet |
| Jose 2021 Facial Reanimation by Modified Intraoral Temporalis Tendon Transfer With Ancillary Procedures. PMID:33704996 | 2021 | this review only | not stated | not extracted yet |
| Krastinova 2023 Temporalis Muscle Transposition in Irreversible Facial Nerve Palsy: A Vestibular Approach. PMID:38288166 | 2023 | this review only | not stated | not extracted yet |
| Krishnan 2010 Outcomes of microneurovascular facial reanimation using masseteric innervation in patients with long-standing facial palsy resulting from… PMID:20651635 | 2010 | this review only | not stated | not extracted yet |
| Mabvuure 2020 The mini-temporalis turnover flap for midface reanimation: Photogrammetric and patient-rated outcomes. PMID:32561385 | 2020 | this review only | Smile asymmetry reduction | not extracted yet |
| Macek 2025 Mini-invasive temporalis muscle tendon transfer and lengthening temporalis myoplasty for facial reanimation - a retrospective outcome… PMID:40967890 | 2025 | this review only | not stated | not extracted yet |
| Martineau 2022 Public and patients' perceptions of facial reanimation using lengthening temporalis myoplasty. PMID:36070979 | 2022 | this review only | Smile asymmetry reduction | not extracted yet |
| Masters 1965 Temporalis transfer for lagopthalmos due to seventh nerve palsy. PMID:5825172 | 1965 | this review only | not stated | not extracted yet |
| May 1984 Muscle transposition for facial reanimation. Indications and results. PMID:6704030 | 1984 | this review only | not stated | not extracted yet |
| May 1993 Temporalis muscle for facial reanimation. A 13-year experience with 224 procedures. PMID:8457301 | 1993 | this review only | not stated | not extracted yet |
| Michaelidou 2009 The combination of muscle transpositions and static procedures for reconstruction in the paralyzed face of the patient with limited life… PMID:19116545 | 2009 | this review only | Lagophthalmos reduction | not extracted yet |
| Miyamoto 2009 Retrospective outcome analysis of temporalis muscle transfer for the treatment of paralytic lagophthalmos. PMID:18639511 | 2009 | this review only | not stated | not extracted yet |
| Neamonitou 2024 Dynamic Surgical Restoration of Mid and Lower Facial Paralysis: A Single-Greek-Centre Experience. PMID:38361724 | 2024 | this review only | not stated | not extracted yet |
| Nguyen 2020 Comparison of Lengthening Temporalis Myoplasty and Free-Gracilis Muscle Transfer for Facial Reanimation in Children. PMID:31609948 | 2020 | this review only | not stated | not extracted yet |
| Oyer 2018 Comparison of Objective Outcomes in Dynamic Lower Facial Reanimation With Temporalis Tendon and Gracilis Free Muscle Transfer. PMID:30325983 | 2018 | this review only | Smile asymmetry reduction | not extracted yet |
| Panciera 2017 Lengthening Temporalis Myoplasty: Objective Outcomes and Site-Specific Quality-of-Life Assessment. PMID:28675099 | 2017 | this review only | Smile asymmetry reduction; Oral commissure displacement improvement | not extracted yet |
| Papadopulos 2020 Α modified temporalis transfer technique for facial paralysis in elderly patients. PMID:32113740 | 2020 | this review only | not stated | not extracted yet |
| Park 2020 Intraoral temporalis transposition for facial reanimation: A novel technique in facial nerve palsy. PMID:32111510 | 2020 | this review only | not stated | not extracted yet |
| Park 2023 Quantitative analysis of facial symmetry and animation following intraoral orthodromic temporalis transfer in facial paralysis. PMID:37353402 | 2023 | this review only | Smile asymmetry reduction; Oral commissure displacement improvement | not extracted yet |
| Patel 2022 Smile Outcomes of an Externally Scarless, Intraoral Orthodromic Temporalis Tendon Transfer. PMID:34287016 | 2022 | this review only | not stated | not extracted yet |
| Scaglioni 2016 Assessment of functional outcomes of temporalis muscle transfers for patients with longstanding facial paralysis. PMID:26752232 | 2016 | this review only | not stated | not extracted yet |
| Schlosshauer 2020 Long-term outcomes of Gillies and McLaughlin's dynamic muscle support in irreversible facial paralysis: A retrospective single-centre… PMID:32327373 | 2020 | this review only | not stated | not extracted yet |
| Sidle 2011 Modification of the orthodromic temporalis tendon transfer technique for reanimation of the paralyzed face. PMID:21493262 | 2011 | this review only | not stated | not extracted yet |
| Singhal 2021 matched by author and year (probable) | NR | this review only | Lagophthalmos reduction | not extracted yet |
| Soares 1997 Temporalis muscle transfer in the correction of lagophthalmos due to leprosy. PMID:9121330 | 1997 | this review only | Lagophthalmos reduction | not extracted yet |
| Sobol 1990 Early facial reanimation following radical parotid and temporal bone tumor resections. PMID:2221238 | 1990 | this review only | not stated | not extracted yet |
| Terzis 2008 Use of mini-temporalis transposition to improve free muscle outcomes for smile. PMID:19050524 | 2008 | this review only | not stated | not extracted yet |
| Terzis 2009 Mini-temporalis transfer as an adjunct procedure for smile restoration. PMID:19182611 | 2009 | this review only | not stated | not extracted yet |
| van Veen 2018a Keeping the fat on the right spot prevents contour deformity in temporalis muscle transposition. PMID:29706553 | 2018 | this review only | not stated | not extracted yet |
| van Veen 2018b Gracilis transplantation and temporalis transposition in longstanding facial palsy in adults: Patient-reported and aesthetic outcomes. PMID:30333080 | 2018 | this review only | not stated | not extracted yet |
| Veyssière 2015 Lengthening temporalis myoplasty and facial paralysis from birth. PMID:25465143 | 2015 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients with facial nerve paralysis undergoing temporalis muscle transfer for facial reanimation | Patients with facial nerve paralysis (n=1354), mostly unilateral, ages 6 to 87 years |
| Intervention | Temporalis muscle transfer (orthodromic, antidromic, minimally invasive, eyelid and combined techniques) | Temporalis muscle transfer: orthodromic (31 studies, 7 minimally invasive), antidromic (7 studies); eyelid reanimation (9 studies); combined (7 studies) |
| Comparison | Not specified | Preoperative status (pre/post comparison) |
| Outcomes | Smile asymmetry reduction, oral commissure displacement improvement, lagophthalmos reduction (objective or clinician-graded); secondary: surgical techniques and complications | Smile asymmetry (8 studies, n=150); oral commissure displacement (5 studies, n=90); lagophthalmos (6 studies, n=182); clinician-graded smile and eyelid outcomes; complications (n=161) |
| Study designs | RCTs, prospective or retrospective observational studies, cross-sectional, case-control and case series of 5 or more patients | Case series (n=49) and cohort studies (n=4) |
| Timing | Latest follow-up timepoint used in meta-analysis | Median follow-up 13.5 months; mean 33.8 months (range 3 months to 25 years) |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | No | Yes | no |
| 2Protocol established before the reviewcritical | No | No | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: N/A · NRSI: Yes | NRSI: Partial Yes · RCT: N/A | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: N/A · NRSI: Yes | NRSI: No · RCT: N/A | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |