What is Muscle Transposition?
Muscle Transposition an operation that borrows a working muscle to replace one that isn't working. This is usually performed to help with drooling and provide a smile on the affected side of the face. The facial (7th cranial) nerve is responsible for moving the corner of the mouth. This nerve doesn't work when there is facial paralysis. The trigeminal (5th cranial) nerve is responsible for closing the jaws. The temporalis muscle is the large muscle on the side of the head that is innervated by the trigeminal nerve. When this muscle is dis-attatched, it can be redirected to the corner of the mouth to provide a more symmetric smile and help with eating problems.

Who is a good candidate for surgery?
If your doctor feels that the facial nerve will not be functioning again, or if you have reached maximum improvement with other therapies, you may be a good candidate for muscle transposition.

How is muscle transposition performed?
The surgeon will make a small incision around the corner of the mouth. A second incision is made vertically in the temple. A pocket is created deep to the skin between the two incisions. The temporalis muscle is then sutured to the muscles around the corner of the mouth, and the incisions are closed. A small drain may be placed for a day or two. Overcorrection is usually necessary since the muscle stretches. Muscle transposition is performed under general anesthesia. An overnight stay in the hospital may be necessary. The operation takes about two hours.

What is the recovery from surgery like?
Recovery from muscle transposition surgery involves several phases. Since general anesthesia is used, you may experience some nausea for the first 24 hours, and you should avoid eating substantial amounts of food. Slight oozing may occur around the incisions. Most people get some bruising and swelling in the cheek, which tends to reach a maximum about 48 hours after surgery. Limiting strenuous activity and keeping the head elevated will cut down on much of the swelling. There may be some bruising which resolves in about 7-9 days. Most of the swelling is gone by two weeks.

When should I come back to the doctor?
Since the sutures dissolve by themselves, there is some leeway about when you may come back to the doctor for a check up. Your doctor will want you to meet with your physical therapist on a regular basis so that the results of the surgery are optimized.

When can I go back to work?
Workers that perform heavy tasks should avoid work for a week or so. After about a week, patients may resume their normal exercise routines. Some office-type workers are able to return to work after 4-5 days to read mail, make phone calls and do some work with the computer.

Will my insurance pay for this?
Most insurance companies consider muscle transposition a functional procedure and do provide coverage.