Several modifications have been described using the temporalis muscle transposition for facial paralysis. Recently, the orthodromic temporalis muscle transposition has gained popularity. The term "orthodromic" refers to the insertion point (coronoid process) of the temporalis muscle being used as the dynamic component.
Orthodromic temporalis muscle transposition involves releasing the muscle at its insertion on the coronoid and attaching it either directly or with the use of tendon graft to the oral commissure. The temporalis muscle origin can also be released either completely or partially, in order to increase muscle reach.