Department of plastic reconstructive and aesthetic surgery, dokuz eylul university, faculty of medicine, izmir, turkey. The temporalis muscle flap can be designed to encompass various tissue types. Temporalis flap for the maxillary defect reconstruction youtube. The temporal muscle fascia lies deep to the tpf over the temporalis muscle. 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. More recently, a split temporalis muscle flap elevated on the superficial temporal pedicle has been described, for which the resulting gain of length makes crossing of the midline possible, as well as reconstruction of substance losses exceeding the midline. The flap is plane, easy to form and contrary to skin flaps has no hair. A bmf was raised intraorally and rotated on its posterior neurovascular pedicle into the defect. Temporalis myofascial flap transfer into the oral cavity without. Pterional craniotomy is a useful approach for the treatment of a variety of intracranial pathologies. The temporoparietal fascia flaps is supplied by the superficial temporal artery and vein. Alternatively, we used reverse deep temporal fascia flap in another case to reach the upper medial part of the orbit.
We investigated the use of the posteriorly based bmf and found that it is a reliable, easily harvested local flap, useful for reconstruction of lesions involving the floor of mouth, retromolar trigone, and soft palate. Like the tpff, the tmf is a reliable, myofascial flap that was also described more than a century ago. At the fall meeting of the american academy of facial plastic and reconstructive surgery held in chicago, ben d. 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. Jul 06, 2012 temporal muscle flap is especially easily predestinated for applying in reconstructive procedures of maxillafacial regions. Temporalis muscle flap for reconstruction of skull base. Temporal muscle flap in reconstruction of maxillofacial tissues. The versatile use of temporoparietal fascial flap cenk demirdover1, baris sahin2 3, haluk vayvada1, hasan yucel oztan 1.
The required area of skin and tissue is moved without interrupting the blood supply. It is a broad, fanshaped muscle on each side of the head that fills the temporal fossa, superior to the zygomatic arch so it covers much of the temporal bone. There was 1 partial flap necrosis that occurred in a patient who had previously received radiation therapy and who healed secondarily without sequelae. Split temporalis muscle flap anatomy, vascularization and. Vascularized rotational temporal bone flap for repair of. The temporalis muscle flap comprises the temporalis muscle, with or without the overlying temporalis fascia. Temporalis muscle flap for reconstruction of skull base defects. 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 temporalis muscle flap for palate reconstruction.
The new reconstruction technique in the treatment of the. Use of the temporalis muscle flap in the dog use of the temporalis muscle flap in the dog tomlinson, james. Buccinator flap as a method for palatal fistula and vpi management. A novel technique allows reconstruction of both the upper and lower. Nov 01, 20 basic principles of local flap in plastic surgery 1. The versatility of temporalis myofascial flap in maxillo. Temporalis muscle flap vula university of cape town. The temporoparietal fascial flap tpff has been used as a pedicled, free, or composite flap with calvarial bone or hairbearing skin in reconstruction of the defects of periorbital, midfacial, auricular regions, and extremities. Because of the limited length of the muscle, and the arc of rotation needed to reach the maxilla, the flap can be brought into the oral cavity by two routes. A wide variety of file folder with flap options are available to you, such as folder, wallet, and bag. Once the coronal flap is raised, the pericranial flap is elevated off of the calvarium down to approximately 1 cm above the supraorbital rims. Use of the temporalis muscle flap in the dog, veterinary.
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. Bhanu prakash usmle, fmge and neet pg 16,856 views. Click download or read online button to get atlas of regional and free flaps for head and neck reconstruction book now. The temporalis muscle flap in reconstruction of intraoral. Facial artery is incorporated in the base of the flap. Available in a variety of sizes, pockets, closures, materials, expansions, and with preprinted and customizable tabs. Anterior craniofacial resection with formal anterior bifrontal craniotomy. In these cases, the muscle may be employed to restore dynamic function to the paralyzed face. Reconstruction with anterior pedicle temporalis flap a case report shirish dubey1, seema dubey2, ajay kumar gupta3, ankush bansal4, arif hossain5, lalita ghosh6 abstract temporomandibular joint tmj ankylosis is one of the most important joint disorders which result from either trauma or due to local and systemic infections. A technique for onestage reconstruction for bony and soft tissue repair after subtotal bilateral maxillectomy is reported. Trauma, previous surgery, irradiation, or carotid occlusion may jeopardize the integrity of the temporoparietal fascia flap.
Simultaneous anterolateral thigh flap and temporalis tendon. Seventeen lower eyelids were evaluated as mild, 12 were as moderate, and 9 were as severe ectropion. Temporalis muscle flap for the reconstruction orofacial defects case reports indian dental academy leader in continuing dental education. Temporal fascia medical animation gross anatomy of head and neck, dr g bhanu prakash duration. Mar 19, 20 for more than a century, the temporalis muscle has been used for facial reconstructions. The aim of this study was to present the outcomes of the technique after 38 operations with 37 patients and to describe deep temporalis musculofascialfatty flap to recover depression of temporalis muscle split donor area. 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. Atlas of regional and free flaps for head and neck. Decompressive craniectomy bone flap hinged on the temporalis. The pericranial flap is reflected forward and covered with a wet lap sponge until it is needed. In this study, the temporalis superficial fascia flap was evaluated as an interpositional material after condylectomy. 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. The benefit of a musculocutaneous flap over a pure muscle flap.
Complete epithelialization gets over in 4 to 6 weeks 2, 10, 15. Defects in the anterior lamella of the eyelids can be readily repaired with skin grafts or flaps but posterior lamellar reconstruction needs more complex applications. Reconstruction of midfacial defects using temporalis. Anatomical basis and results of the facial artery musculomucosal flap for oral reconstruction. The anatomy and surgical technique of the temporalis myofascial flap has been well documented. Temporalis myofascial flap for primary cranial base. Aggressive gap arthroplasty together with interposition of temporalis myofascial flap is a. The temporalis muscle flap comprises the temporalis muscle. 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. Cosmetic reconstruction of frontotemporal depression using. In the years 19962010 we treated 10 patients with malignant neoplasms of maxillofacial region. In one case of flap applied into the oral cavity for tightly separate from nasal, partial necrosis of flaps edge and oronasal fistula occurred.
The temporalis muscle flap and temporoparietal fascial flap. Jun 14, 2016 the temporalis muscle is found deep to the temporalis muscle fascia. The temporalis osteomyoperiosteal flap its blood supply. Reconstruction of temporomandibular joint ankylosis with temporalis myofascial flap in a cat. However, its use for repair of skull base defects is less commonly reported. Cadaver dissections, injection studies, and histological investigations were performed. Care must be taken not to disrupt the deep branches of the supraorbital and supratrochlear vessels. Indications the anterior pericranial and galeofrontalis flaps have been used extensively for anterior skull base and craniofacial reconstruction. Reconstruction of intraoral defects using facial artery musculomucosal flap. Simultaneous anterolateral thigh flap and temporalis. Its values are axial vascularization, location close to reconstruction site, easy harvest and good results with its use. Conclusion patients suffering from tmj ankylosis are not only affected functionally but also esthetically, and the loss of mandibular function leads to various psychosocial problems. Pedicled temporalis muscle flap for craniofacial reconstruct. The osseous mass is resected and the joint reconstructed by autogenous bone grafts or a total joint prosthesis.
Twostage temporalis flap reconstruction for facial. Temporalis muscle hypertrophy is a rare clinical entity and only a few cases are reported. Efficacy of temporalis myofascial flap as an interpositional. 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 arise from the internal maxillary system deep to the zygomatic arch. Pdf the temporalis muscle flap for palate reconstruction. Ideal for oral and maxillofacial surgeons, facial plastic surgeons, and head and neck surgeons, the book serves as a useful guide to planning reconstructive cases and an easily. Jan 12, 2015 the temporalis flap remains as one of the reconstructive options for patients with facial paralysis. We performed posterior lamellar eyelid reconstruction with. Presents our experience in reconstruction of postsurgical defects with use of temporal muscle flap. Temporalis myofascial flap tmf and immediate soft tissue. Clinic of plastic reconstructive and aesthetic surgery, public hospital, mus, turkey. 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 novel technique allows reconstruction of both the upper and lower eyelids using the temporalis muscle in combination with local flaps. Ideal for oral and maxillofacial surgeons, facial plastic surgeons, and head and neck surgeons, the book serves as a useful guide to planning reconstructive.
Evolution golovine 1898 reconstruction after orbital exenteration. Temporalis muscle flap for the reconstruction oro facial. Once the epithelialization is complete, the new mucosal surface covering the muscle is indistinguishable from surrounding mucosa 10. The operation is a twostaged procedure where free temporalis fascial graft is placed through an external incision around the oral commissure. The vascular supply is the deep temporal artery, which originates from the internal maxillary artery fig. 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 present study was performed to determine the postoperative outcomes of patients following frontotemporal depression.
Temporalis flap for the maxillary defect reconstruction. All the flaps of temporal muscle that were used for reconstructing eye sockets incorporated with no local reaction. It presents descriptions of anatomy and anatomical. A practical approach provides comprehensive, stepbystep instruction for flap raising and insetting for the head and neck region. The temporalis muscle flap tmf is a valuable reconstructive technique utilized in a variety of challenging defects. The temporalis muscle lies deep to the temporoparietal fascia. The temporal muscle, also known as the temporalis, is one of the muscles of mastication. Sep 04, 2019 regional flaps, such as the temporalis muscle flap, or free flaps such as the radial forearm, involve extensive extraoral dissection and are better reserved for larger defects. This graft is harvested from the contralateral scalp. Orthodromic temporalis tendon transfer additionally provides for immediate facial symmetry and restoration of oral competence with early cornerofmouth movement. Difficulty of reconstruction of the eyelids arises from the need to reconstruct different supporting and covering structures in a single operation.
However, it can result in temporal hollowing, which causes significant craniomaxillofacial asymmetry and esthetic deformity. Temporalis muscle flap and temporoparietal fascia flap. I read the article by zeiler and kaufmann 15 with interest zeiler fa, kaufmann am. Vascularized rotational temporal bone flap for repair of anterior skull base defects. The temporalis osteomyoperiosteal flap its blood supply and. Jun 04, 2018 although the temporoparietal fascia flap is highly vascular and reliable, prior injury to the temporal field could result in flap necrosis. For more than a century, the temporalis muscle has been used for facial reconstructions. 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. Modified temporalis muscle flap for eyelid reanimation. In the series after 1994, flaps were most commonly used for. This report introduces a new classification system mainly based on the remaining attachments of buccinator muscle after flap elevation in pedicle variants and axial blood supply orientation in island variants.
Reconstruction of temporomandibular joint ankylosis with. The fascia is superficial to the deep temporal fascia, and just below the hair follicles of the scalp. Temporal muscle flap is especially easily predestinated for applying in reconstructive procedures of maxillafacial regions. 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. Surgical treatment of bilateral temporalis and masseteric. The temporalis muscle flap illustrated in this video is commonly used as a reliable method to reconstruct palate defects.
The temporalis muscle flap provides abundant well vascularized tissue and has been described for head and neck reconstruction. Dec, 2019 buccinator flap as a method for palatal fistula and vpi management. The temporoparietal fascia tpf is an extension of the subcutaneous musculoaponeurotic system smas inferiorly and the galea aponeurotica superiorly. 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 free flap grafting. Aug 09, 2017 temporal fascia medical animation gross anatomy of head and neck, dr g bhanu prakash duration. The authors mention that they discuss a novel technique of skull base reconstruction using a vascularized.
Temporalis muscle flap and temporoparietal fascia flap ento key. Kim college of veterinary medicine, chonbuk national university, jeonju, republic of korea abstract. This text describes surgical procedures, techniques and approaches used in major flap transfers for reconstructive headandneck surgery. The flap adds protection and security and allows you to take your files wherever you go. More often, it presents a bilateral involvement and is usually associated with masseteric hypertrophy 3. Twostage temporalis flap reconstruction for facial paralysis. About three to six weeks later, an ipsilateral temporalis muscle and fascia transfer is made to this previously placed graft. This thin, pliable, and highly vascularized flap, accepts skin grafts on both sides. The temporalis flap remains as one of the reconstructive options for patients with facial paralysis.
Temporal muscle flap in reconstruction of maxillofacial. In the series after 1994, flaps were most commonly used for reconstruction of. The aim of this report is to present a case of bilateral temporalis and masseteric muscles hypertrophy treated surgically. Treatment of temporomandibular joint ankylosis with. The anatomy, surgical technique, indications and results are described for each flap, using seven representative cases. Temporalis muscle flap operative techniques in otolaryngology. Temporalis muscle flap heals with secondary epithelialization, unless the flap is traumatized by occluding teeth. Cadaver dissections, injection studies, and histological. 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 to transfer the muscle to the oral cavity. It provides a thin sheet of vascularized fascia based on the superficial temporal artery and vein.
Keep your desk, work surface or countertop organized with a smead expanding file. Dec 21, 2019 buccinator flap as a method for palatal fistula and vpi management. Dec 11, 20 the temporalis flap in otolaryngology for more than 20 years, broadcastmed has been innovating digital strategies for healthcare organizations. It is usually divided during elevation of the flap, forming and insensate are on the lateral scalp. 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. This is based on the direct anastomosis between the fascial branch of the middle temporal artery and the deep temporal network and the sparse network of branches be.