Smile Outcomes of an Externally Scarless, Intraoral Orthodromic Temporalis Tendon Transfer.

Temporalis tendon transfer (TTT often relies on external incisions in the nasolabial fold, temporal region, or both. Herein, we studied smile outcomes of a TTT technique via a single intraoral incision without external skin incisions. To measure the difference in static perioral positions before and after intraoral TTT. Five patients underwent an externally scarless TTT technique via an intraoral approach. Iris measurements were used to estimate pixel-to-millimeter conversion for facial analysis of vertical and horizontal oral commissure excursion vectors using the JAVA-based program Facegram version 1.0 (Massachusetts Eye & Ear Infirmary). After surgery, mean vertical height on the affected side significantly increased from 3.4 mm to a postoperative value of 20.6 mm,  = 0.016. There was no difference in horizontal smile excursion after surgery (35.7 mm vs. 32.2 mm,  = 0.37). Smile angle difference between affected and healthy smile (Δα) reduced from 27.0° preoperative to 3.5°, representing a decrease in facial asymmetry ( = 0.002). Intraoral, externally scarless TTT is an effective option for dynamic facial reanimation, obviating external incisions in select patients.