About three to six weeks later, an ipsilateral temporalis muscle and fascia transfer is made to this previously placed graft. Its values are axial vascularization, location close to reconstruction site, easy harvest and good results with its use. The flap was then turned down over the arch and into the fossa. High voltage electric burn repair of the forehead by. Reverse flow temporalis muscle flap first was first described and used by kim and park for the closure of a large anterior cranial base defect with direct intracranialnasopharyngeal communication. Temporalis myofascial flap transfer into the oral cavity without. Pdf the use of temporalis muscle pedicled flap for. Clinical significance a temporalis fascia transposition flap can be used to reconstruct the ventral aspect of the orbit in dogs.
Pedicled tragal chondral flap for irreparable temporomandibular joint disc longterm performance of temporalis muscle flap when used as a disc replacement flap flap within a flap. The operation is a twostaged procedure where free temporalis fascial graft is placed through an external incision around the oral commissure. The benefit of a musculocutaneous flap over a pure muscle flap. Dissection is carried through the deep temporal fascia, providing visualization of the verticallyoriented temporalis muscle. Additional ventral support of the globe after ventral orbitectomy via a temporalis fascia transposition flap resulted in an excellent functional and cosmetic outcome. Assessment of functional improvement with temporalis. Temporalis muscle flap for reconstruction of skull base defects. During the transfer of the muscle, only a small volume and size of the muscle can reach to the defect, remaining most of the muscle bulk in the pedicle and a relatively limited arc of rotation. Aug 12, 2015 the purpose of this study was to investigate the functional effects of temporalis myofascial flap after condylectomy, with or without disc removal, in elderly patients with anterior disc displacement add without reduction and an erosive condylar surface of the temporomandibular joint tmj. Temporal muscle flap is especially easily predestinated for applying in reconstructive procedures of maxillafacial regions. Kim college of veterinary medicine, chonbuk national university, jeonju, republic of korea abstract. The temporalis muscle flap for reconstruction of soft palate.
With the presence of a fistula, the maxillary sinus is permanently open. Maxillofacial surgery, at our institute, to study the versatility of temporalis myofascial flap in maxillofacial reconstruction. Subsequently, this flap was used in reconstructions involving several head and neck regions including the mastoid, 3 maxilla, 4. Oct 29, 20 temporalis muscle flap for the reconstruction oro facial defects case reportsoral sugery certified fixed orthodontic courses by indian dental academy 1.
Clinical significance a temporalis fascia transposition flap can be used to. A oneside pedicled temporalis osteomyoperiosteal flap is used for reconstruction of oral and nasal lining, maxillary bone, and oral, as well as nasal, soft tissue lining of the velum. To present the experience using temporal muscle pedicled flaps for the reconstruction of extensive cheek defects after cancer. For three years we have used the temporalis muscle flap for reconstruction of intraoral defects. Temporalis myofascial flap for maxillofacial reconstruction. The temporalis flap and its rarely used counterpart, the masseter muscle transfer is unique among these choices in that the effect is immediate. Cadaver dissections, injection studies, and histological investigations were performed. The temporalis system has been used for maxillofacial reconstruction since the late 1800s and continues to serve as a reservoir of tissue for the contemporary surgeon. The artery is a branch of the external carotid system. Efficacy of temporalis myofascial flap as an interpositional. The temporalis osteomyoperiosteal flap its blood supply. Two of these, the temporoparietal tp fascia and temporalis flaps, are most commonly used for reconstructing defects in the head and neck because of their proximity, reliability, and adaptability.
For intraoral reconstruction, the temporalis muscle flap has advantages over the standard workhorse flap, the pectoralis major. This graft is harvested from the contralateral scalp. An ipsilateral temporalis fascial flap raised with. Extensive traumatic anterior skull base fractures with. Reconstruction of the orbit with a temporalis muscle flap after. Both are described here, including their indications, anatomy, and flapharvesting technique, along with contraindications and potential complications. Facial reanimation procedures depicted on radiologic. The temporalis muscle flap represents an excellent alternative in reconstruction of otherwise difficulttoreconstruct defects of the nasopharynx, oropharynx, and base of tongue.
Like the tpff, the tmf is a reliable, myofascial flap that was also described more than a century ago. Anterior craniofacial resection with formal anterior bifrontal craniotomy. Temporalis muscle flap for reconstruction of skull base. Jan 12, 2015 the temporalis flap remains as one of the reconstructive options for patients with facial paralysis. The blood supply of the tpf flap is from the superficial temporal artery and vein.
We describe a technique for temporalis muscle resuspension utilizing multihole cranial plates and screws to recreate the superior temporal line on an otherwise smooth synthetic cranioplasty implant. Use of a temporalis fascia transposition flap for ventral. Temporalis muscle and fascia flap in treatment of tmj. Note that free tissue transfer, similar to other nerve crossover procedures, requires a period of reinnervation, which invariably requires many months. Temporalis myofascial flap for primary cranial base. A the temporoparietal fascia is elevated with a skin flap. The temporalis flap is one of the first reported muscle flaps described by lentz 1 in 1895, who used it after resection of the condylar neck for temporomandibular joint ankylosis. Temporalis muscle flap and temporoparietal fascia flap ento key.
Vascularized rotational temporal bone flap for repair of. Temporalis flap for the maxillary defect reconstruction. A oneside pedicled temporalis osteomyoperiosteal flap is used for reconstruction. The temporalis muscle flap for intraoral reconstruction. Fascia temporalis free flap for cricotracheal reconstruction. Efficacy of temporalis myofascial flap as an interpositional graft material in the management of tmj ankylosis. The authors divided the cases into two seriesbefore and after 1994because, after 1994, they started to perform free flap reconstructions, and indications for reconstruction with a temporalis muscle flap were changed results.
Jan 17, 2017 the flap was raised in the loose areolar plane above the pericranium figure 2. The versatility of temporalis myofascial flap in maxillo. Temporalis tendon transfer as part of a comprehensive. Temporalis flap for the maxillary defect reconstruction youtube. Pedicled temporalis muscle flap for craniofacial reconstruct. Indications the anterior pericranial and galeofrontalis flaps have been used extensively for anterior skull base and craniofacial reconstruction. Decompressive craniectomy bone flap hinged on the temporalis. The purpose of this article is to briefly describe the surgical technique, report on our use of the temporalis muscle flap for reconstruction of intraoral defects, and. Jul 06, 2012 temporal muscle flap is especially easily predestinated for applying in reconstructive procedures of maxillafacial regions. A total of 15 joints from 11 elderly patients 7178 years old were included. Autogenous temporalis fascia patch graft for porous. The company was first in the world to broadcast live surgeries on the internet using its orlive solution which provides an intimate look inside the operating room. The anatomy and surgical technique of the temporalis myofascial flap has been well documented.
The vascularized rotational temporal bone flap, in which a temporalis muscle pedicle is used, provides a novel and easily accessible means of vascularized bone closure of anterior skull base defects without the need for microsurgical freeflap grafting. Ankylosis, temporalis muscle, fascia flap, temporomandibular joint, interpositional arthroplasty guruprasad, yadavalli, singh chauhan, dinesh on. Above the temporalis muscle, the pericranium and skull lie deep to the tpf. Reconstruction of temporomandibular joint ankylosis with temporalis myofascial flap in a cat. Temporalis muscle flap for the reconstruction oro facial. The temporoparietal fascia tpf is an extension of the subcutaneous musculoaponeurotic system smas inferiorly and the galea aponeurotica superiorly. The temporalis myofascial flap is classified as type iii axial pattern flap, based on two dominant arterial pedicle that is anterior and posterior deep temporal arteries it is because of this dependant vascular supply the temporalis myofascial flap is a versatile option for reconstruction of moderate to large sized maxillofacial defects, the. The study group comprised of 20 patients, both male and female patients between the age group of 6 years and 60 years underwent surgery under general anesthesia and temporalis myofascial flap was used for reconstruction of various types of maxillofacial defects including maxillectomy defects arising as a result of ablative surgery for tumors and treatment of. A contemporary analysis of hospital charges in the united states next article videoassisted thoracic surgery thymectomy versus sternotomy thymectomy in patients with thymoma. The temporalis osteomyoperiosteal flap its blood supply and. Evolution golovine 1898 reconstruction after orbital exenteration. The temporalis system of flaps in head and neck reconstruction. Temporalis muscle suspension on synthetic cranioplasty.
Temporal muscle flap in reconstruction of maxillofacial. Advantages of this flap are that it is nonhairbearing, nonbulky, pliable, durable, proximal to intraoral defects, and it results in better articulation and deglutition. The scalp flap is undermined for 1 or 2 cm before the deep temporal fascia and underlying temporalis muscle are incised. Temporalis muscle flap and temporoparietal fascia flap.
Use of the temporalis muscle flap in the dog use of the temporalis muscle flap in the dog tomlinson, james. A similar evaluation of using temporal flap for restoration of hard palate following maxillary resection is presented by other authors 15, 7, 12, 14. Twostage temporalis flap reconstruction for facial. In addition to the galeal flap, several other flaps, such as the. Because of its unique blood supply, the temporal area provides a tripartite system of flaps for reconstruction. Temporalis myofascial flap for primary cranial base reconstruction. In 1898, golovine 2 used the flap to reconstruct an orbital exenteration defect. Temporalis muscle flap used to reconstruct a surgical defect following ablation of squamous cell carcinoma, 10 days after surgery. Longterm performance of temporalis muscle flap when used as a disc replacement. The temporalis muscle flap for reconstruction after head and. The temporalis flap temporalis muscle transposition procedure is an effective option for reanimation of the smile. Objective to explain the applications, technique, and potential complications of the temporalis muscle flap used for immediate or delayed reconstruction of head and neck oncologic defects study design fresh cadaver dissection and 5. Temporalis muscle flap does not reach to the midline of the forehead region because of the insufficient length of the deep temporal vascular system. The temporalis muscle flap for reconstruction of soft.
Bhanu prakash usmle, fmge and neet pg 16,856 views. Temporalis muscle flap for immediate reconstruction of. Dec 11, 20 the temporalis flap in otolaryngology for more than 20 years, broadcastmed has been innovating digital strategies for healthcare organizations. The present study was done to evaluate the efficacy of interpositional arthroplasty with temporalis muscle and fascia myofascia flap in preventing the reankylosis, to evaluate the growth of mandible, and to assess alkayat and bramleys incision for its versatility in allowing muscle transfer and excellent exposure of the joint. In these cases, the muscle may be employed to restore dynamic function to the paralyzed face. The zygomatic arch and lateral orbital wall of the out er surface are exposed. The temporalis muscle is found deep to the temporalis muscle fascia. Temporal fascia medical animation gross anatomy of head and neck, dr g bhanu prakash duration. Treatment of temporomandibular joint ankylosis with. The utility of the temporalis muscle flap for oropharyngeal. Trauma, previous surgery, irradiation, or carotid occlusion may jeopardize the integrity of the temporoparietal fascia flap. Temporalis muscle and fascia flap in treatment of tmj ankylosis. It provides a thin sheet of vascularized fascia based on the superficial temporal artery and vein. A total of 15 joints from 11 elderly patients 7178 years old.
The temporalis muscle flap for reconstruction after head. Temporal augmentation with methyl methacrylate aesthetic. The temporalis osteomyoperiosteal flap its blood supply and use for. Temporalis muscle flap for the reconstruction orofacial defects case reports indian dental academy leader in continuing dental education. Since the blood supply to the muscle enters on its deep surface, it is unlikely that it has been compromised unless the patient has previously undergone surgical approaches to the infratemporal fossa or lateral skull.
An ipsilateral temporalis fascial flap raised with the superficial temporal artery was then carried out. Donor site aesthetics are well accepted by patients with primary hydroxyapatite cement cranioplasty with or without secondary lipotransfer. At the fall meeting of the american academy of facial plastic and reconstructive surgery held in chicago, ben d. The flap was raised in the loose areolar plane above the pericranium figure 2. Twostage temporalis flap reconstruction for facial paralysis. Doppler ultrasonography should be used preoperatively to determine the reliability of the superficial temporal artery and to map the course of the main pedicle, frontal branch, and parietal branch. The temporal muscle fascia lies deep to the tpf over the temporalis muscle. A novel approach previous article ecmo support in lung transplantation. Reconstruction of temporomandibular joint ankylosis with. The flap was then transposed into the defect though it covered only about twothirds of the defect. Pdf extended temporalis flap for skull base reconstruction. The flap is plane, easy to form and contrary to skin flaps has no hair. Jun 04, 2016 temporalis flap likewise, when a temporalis flap is considered, the area should be examined for evidence of previous surgery. This article explores the surgical anatomy and application of.
The versatility of temporalis myofascial flap in maxillofacial. The temporalis muscle flap in reconstruction of intraoral defects. A technique for onestage reconstruction for bony and soft tissue repair after subtotal bilateral maxillectomy is reported. Pdf the versatility of temporalis myofascial flap in maxillofacial. Aug 09, 2017 temporal fascia medical animation gross anatomy of head and neck, dr g bhanu prakash duration. In the series after 1994, flaps were most commonly used for.
High voltage electric burn repair of the forehead by reverse. The aim of this study was to identify potential risk factors for exposure of porous polyethylene medpor sphere implants and evaluate the use of autogenous temporalis fascia as a patch graft for exposure. The temporalis flap remains as one of the reconstructive options for patients with facial paralysis. Excellent reliability exists with the use of these flaps, making them the procedure of choice for a number of ablative and traumatic surgical defects. The second application of the temporal muscle flap was tilling the orbit andor covering dura mater of anterior cranial fossa uncovered during removal of neoplasm from this region. In the series after 1994, flaps were most commonly used for reconstruction of. Temporalis fascia has been recommended for hydroxyapatite sphere exposure. The vascular supply is the deep temporal artery, which originates from the internal maxillary artery fig. The vascular supply is the deep temporal artery, which originates from. The advantage of the temporalis muscle flap is the ease of access to the muscle, the moderate quantity of muscle that can be harvested, and the ability. The temporalis muscle flap illustrated in this video is commonly used as a reliable method to reconstruct palate defects. The study group comprised of 20 patients, both male and female patients between the age group of 6 years and 60 years underwent surgery under general anesthesia. Use of the temporalis muscle flap in the dog, veterinary.
In this series of seven patients, we used the temporalis muscle flap for reconstruction of tongue and floorofmouth defects. The temporalis muscle flap tmf is a valuable reconstructive technique utilized in a variety of challenging defects. The temporalis muscle flap is generally thought to be a straightforward, reliable, regional flap with axial blood supply, and adequate bulk and flexibility for many craniofacial defects. Sixmonth postoperative, showing a total closure of the palate and the flap surface. The temporalis myofascial flap is an autogenous graft that has the advantages of close proximity to the temporomandibular joint, minimal surgical morbidity, and successful clinical results.
Anterior pericranial and galeofrontalispericranial flaps. Temporal muscle flap in reconstruction of maxillofacial tissues. Despite these descriptions of its use in head and neck reconstruction, the flap remained an obscure and underused tool until an explosion of new descriptions of it. Cadaver dissections, injection studies, and histological. Pedicle temporalis fascial flap with axial scalp flap. The purpose of this study was to investigate the functional effects of temporalis myofascial flap after condylectomy, with or without disc removal, in elderly patients with anterior disc displacement add without reduction and an erosive condylar surface of the temporomandibular joint tmj. However, its use for repair of skull base defects is less commonly reported. Radiation therapy, trauma, or previous surgery around the superficial temporal arteriovenous supply may increase the risk of flap necrosis and should be considered relative contraindications. The pedicled temporalis muscle flap is a reliable and highly versatile flap that receives blood supply from the anterior and posterior deep temporal arteries, which.
It is an axial flap based on the anterior and posterior deep temporal arteries. In 1898, the temporoparietal fascia flap was described nearly simultaneously for reconstruction of the external ear after a horse bite and for reconstruction of the lower eyelid. The temporalis muscle flap is far less bulky, more pliable, nonhair bearing, and in closer proximity to the oral cavity. Jun 04, 2018 although the temporoparietal fascia flap is highly vascular and reliable, prior injury to the temporal field could result in flap necrosis. Efficacy of interpositional arthroplasty with temporalis.