Immediate reconstruction of palatomaxillary defect following. Of all regional flaps, the temporalis myofascial flap tmf provides a high degree of reliability, vascularity, adequate bulk, and proximity to the defect in the oral and maxillofacial region. It is a very reliable, versatile flap that is usually available in the operative field with relatively low donor site aesthetic and functional morbidity. Obliteration of mastoid avity with temporalis muscle. In 1898, golovine 2 used the flap to reconstruct an orbital exenteration defect. Pedicled temporalis muscle flap for craniofacial reconstruct. The artery is a branch of the external carotid system. Transposition of the temporalis myofascial flap results in permanent aesthetic stigma in the donor site. The temporoparietal fascial flap and the temporalis muscle. Temporalis muscle flap can support immediate or delayed free bone graft 6,30. Free flap reconstruction of palate defects is also a popular method used by. The unelevated muscle remains viable within the temporal fossa, limiting the cosmetic deformity 3. Temporalis muscle flap and temporoparietal fascia flap.
Bony midfacial defects that need reconstruction are alveolar ridge defects. Pdf the versatility of temporalis myofascial flap in maxillofacial. The temporalis muscle flap for reconstruction after head and. Temporalis myofascial flap for primary cranial base reconstruction. 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.
Free flap reconstruction of palate defects is also a popular method used by contemporary surgeons. Use of porous polyethylene for correcting defects of. The temporalis muscle flap for palate reconstruction. 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. Among the flaps proposed, the temporalis muscle flap tmf is a reliable and safe myofascial flap that has been used for the reconstruction of various maxillofacial defects cordeiro and santamaria, 2000, hanasono et al. Original article simultaneous anterolateral thigh flap and temporalis tendon transfer to optimize facial. Menderes a, yilmaz m, vayvada h, demirdover c, barutcu a.
E and f, the reconstruction set in place mf, galeal frontalis myofascial flap. Most commonly, the myofascial diagnosis will be of tmj temporomandibular joint dysfunction. This study aimed to compare the shortterm clinical consequences between these 2 interpositional materials in patients with operated tmj ankylosis. The temporalis myofascial flap is a versatile option for reconstruction of. The temporalis myofascial flap is a versatile option for reconstruction of moderate to large sized maxillofacial defects, the muscle can provide abundant viable and vascular tissue, with minimal to no functional morbidity or esthetic deformity at the donor site.
It can also be used as a composite myofascial flap with cranial bone 31. Pdf temporalis myofascial flap for primary cranial base. The inferior border of the zygoma was identified and the masseter muscle origin divided. Figure 2 schematic drawing of the temporalis myofascial flap transposition. The temporalis muscle flap is a reliable, nonbulky, myofascial flap that has been used for closure of a variety of defects as well as reconstruction both of medium and large areas of the maxillofacial region. The temporal muscle fascia lies deep to the tpf over the temporalis muscle.
It is a very reliable, versatile flap that is usually available in the operative field with relatively low. Temporalis muscle flap and temporoparietal fascia flap ento key. Oral and maxillofacial soft tissue reconstruction using local flaps in sokoto, northwest nigeria abdurrazaq olanrewaju taiwo 1, ramat oyebunmi braimah 1, adebayo aremu ibikunle 1, micah olalekan gbotolorun 2, mike adeyemi 2, benedict chukwuma 1, siddiq abubakar 1 1 department of dental and maxillofacial surgery, college of health sciences, usmanu danfodiyo university teaching hospital. Past studies have shown the temporalis myofascial flap to be safe as well as effective. In 1895, the temporalis flap was first utilized by lentz after resection of the condylar neck for temporomandibular joint ankylosis. G, at 6 months, there was no radiographic evidence of absorption of the bone graft. 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 use of the temporalis myofascial flap in oral cancer. Bhanu prakash usmle, fmge and neet pg 16,818 views. It is an axial flap based on the anterior and posterior deep temporal arteries. Reconstruction of midfacial defects using temporalis muscle flap. Vascularization, flexibility and the fascia with the muscle are the chief advantages of myofascial flaps 2. Subsequently, this flap was used in reconstructions involving several head and neck regions including the mastoid, 3 maxilla, 4. Cosmetic deformities that appear following pterional craniotomy are usually caused by temporal muscle atrophy, injury to the frontotemporal branch of the facial nerve, or bone pits in the craniotomy line. The temporoparietal fascial flap, on the other hand. Recent trends seem to favor free flap reconstruction for hard palate defects, when the temporoparietal fascial tpf flap or temporalis muscle tm flap are viable options affording a quicker, more efficient alternative for reconstruction. Functional outcomes and suitability of the temporalis myofascial flap for palatal.
Jun 04, 2018 in 1983, brent et al reported the successful use of the flap as an axialpattern fascial flap, a randompattern fascial flap, and a free fascial flap for secondary ear reconstruction. The versatility of temporalis myofascial flap in maxillofacial. The myofascial flap is easy to manage as compared to free microvascular flaps. For these reasons, free tissue transfer is becoming the preferred technique for repair of softtissue defects after parotidectomy. The authors present personal experience in the use of a porous polyethylene prosthesis to camouflage the temporal defects following transposition of the temporalis myofascial flap. Temporalis myofascial flap theproximity ofthetemporalis muscle to themaxilla, ethmoid bone, orbit, nasophar. Excellent cosmetic and functional results have been obtained. Request pdf the use of the temporalis myofascial flap in oral cancer patients the purpose of this article is to present our experience using the simple, reliable, and predictable temporalis. Experience gained with 26 temporalis flaps in reconstruction of tissue defects in the periorbital region, skull base, maxilla, and oral cavity is presented. Anatomy the temporalis muscle is a fanshaped muscle that originates from the temporalis fascia and from the temporal fossa. Jun 14, 2016 the temporalis muscle is found deep to the temporalis muscle fascia. Immediate reconstruction of palatomaxillary defect. In the series after 1994, flaps were most commonly used for reconstruction of. Cosmetic and functional reconstruction achieved using a split myofascial bone flap for pterional craniotomy.
Treatment of temporomandibular joint reankylosis by. Temporalis myofascial flap for primary cranial base reconstruction after tumor resection article pdf available in skull base surgery 184. Efficacy of temporalis myofascial flap as an interpositional graft material in the management of tmj ankylosis. Patients and method this series of 9 patients 6 men and 3 women, were treated at the department. It provides a thin sheet of vascularized fascia based on the superficial temporal artery and vein.
Each of these reconstructive modalities has its specific indications, advantages, and drawbacks. Temporalis myofascial flap for maxillofacial reconstruction. Six of 11 patients underwent palate reconstruction with a microvascular free. Temporalis a broad, flat muscle on each side of the head, which is a key muscle in mastication. Where free tissue transfer is not feasible, local flaps remain a viable option. 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. Cosmetic and functional reconstruction achieved using a split. However, an additional anchoring technique is proposed that can lead to a better result by preventing postoperative fibrous adhesions or reankylosis from flap dislocation due to instability. Temporalis myofascial flap transfer into the oral cavity without zygomatic arch osteotomy david p tauro 1, madan mishra 2, gaurav singh 2 1 the taulins clinic, center for craniomaxillofacial, plastic and reconstructive surgery, bangalore, karnataka, india 2 department of oral and maxillofacial surgery, sardar patel postgraduate institute of dental and medical sciences, lucknow, uttar pradesh. Temporal fascia medical animation gross anatomy of head and neck, dr g bhanu prakash duration.
Introduction the temporalis myofascial tm is an important reconstructive flap in palate reconstruction. The temporoparietal fascia tpf is an extension of the subcutaneous musculoaponeurotic system smas inferiorly and the galea aponeurotica superiorly. In our case simultaneous reconstruction was performed with a temporalis myofascial flap for obliteration of the maxillary sinus and nasal cavities. Reconstruction of the anterior cranial base with the galeal. Use of temporomyofascial flap for reconstruction of. Oral and maxillofacial soft tissue reconstruction using. The temporalis muscle is found deep to the temporalis muscle fascia.
The enhancing, thin, curvilinear pericranial flap bridges an osseous defect of the anterior skull base. The authors have used this method in the treatment of 40 patients over the last 3 years. Pdf cosmetic and functional reconstruction achieved using a. Temporal muscle flap in reconstruction of maxillofacial tissues. Orbital skull base reconstruction with temporalis muscle. This essay describes the relevant anatomy andnormal ctand mr imaging appearance ofthetemporalis myo fascial flap. Like the tpff, the tmf is a reliable, myofascial flap that was also described more than a century ago.
However, an additional anchoring technique is proposed that can lead to a better result by preventing postoperative fibrous adhesions or reankylosis from flap dislocation due to. Reverse temporalis muscle flap for the reconstruction of orbital exenteration defects. Restoration of neural input provides the patient the best chance of longterm. Tham 2 peter costantino2 1department of otolaryngology, university of new mexico, albuquerque, new mexico, united states 2department of otolaryngology, new york head and neck institute, newyorkcity,newyork,unitedstates. Of the 11 patients, 6 had successful reconstruction of the palate, and all patients. Opting for a regional flap over a free flap also avoids the. Original article simultaneous anterolateral thigh flap. The temporalis myofascial flap was found to be an excellent reconstructive alternative for a wide variety of skull base defects following tumor ablation. Muscles that can cause pain in the teeth due to myofascial trigger points include. Most commonly used regional myofascial flaps for midfacial defects are cervicofacial rotation flap, forehead flap 8, and temporalis muscle flap. To date, the temporalis myofascial flap has been used only to a limited extent for reconstruction in the maxillofacial region. Efficacy of temporalis myofascial flap as an interpositional.
Efficacy of interpositional arthroplasty with temporalis. The blood supply of the tpf flap is from the superficial temporal artery and vein. The vascular supply is the deep temporal artery, which originates from the internal maxillary artery fig. Mandibular condyle and infratemporal fossa reconstruction. Preservation of the frontotemporal branch of the facial nerve using the interfascial temporalis flap for pterional craniotomy.
The temporalis myofascial flap is a versatile option for reconstruction of moderate to large. Considerations for freeflap reconstruction of the hard. Comparison of clinical efficacy of temporalis myofascial fla. Mandibular condyle and infratemporal fossa reconstruction using vascularized costochondral and calvarial bone grafts 85 tion, including deep circumflex iliac artery free flap, second metatarsal free flap, sternoclavicular free flap, and costochondral free flap. Cosmetic and functional reconstruction achieved using a. 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. Temporalis myofascial flap transfer into the oral cavity. Microvascular free flap reconstructive options in patients. To resolve these problems during pterional craniotomy, an alternative method was developed in which a split myofascial bone flap and a free bone flap are used. 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. On imaging studies, the tendon and fractured coronoid process are clues to the presence of a temporalis myofascial flap. The temporalis muscle flap is a reliable, nonbulky, myofascial flap that has been used for closure of a variety of defects as well as reconstruction. Twenty patients with tmj ankylosis were randomized in 2 age and sexmatched 10patient groups. Comparison of clinical efficacy of temporalis myofascial.
Temporal muscle flap in reconstruction of maxillofacial. The temporalis muscle flap for reconstruction after head. Temporalis muscle flap vula university of cape town. Reconstruction of midfacial defects using temporalis. Similar findings and flap attributes were demonstrated by the use of the rectus abdominus free flap. Versatility of temporalis myofascial flap in maxillofacial reconstruction analysis of 30 cases. The knots, or trigger points, in this muscle refer or send pain to the regions denoted in red including the teeth. In 1993, cheney et al described 21 cases using the flap for a variety of reconstructions in the head and neck. The role of the temporalis myofascial and pericranial flap in reconstruction of the orofacial region. The temporalis muscle and facial flap, as well as the dermal graft, are among the most popular ones. Most of our cases had no associated complications 39 92. Above the temporalis muscle, the pericranium and skull lie deep to the tpf.
Use of porous polyethylene for correcting defects of temporal. Temporalis myofascial flap in maxillary reconstruction. The utility of the temporalis muscle flap for oropharyngeal, base of tongue, and nasopharyngeal reconstruction. Temporalis muscle is one of the regional flaps that can be used to reconstruct midfacial defects. Coloured areas illustrate the different ostectomies performed.
The technique of flap elevation and transposition is the. The rectus abdominis free flap demonstrates similar flap attributes and similar postoperative results. Imad abuel naaj, yoav leiser, ronit liberman and micha peled, the use of the temporalis myofascial flap in oral cancer patients, journal of oral and maxillofacial surgery, 10. Temporalis muscle flap operative techniques in otolaryngology. Temporalis myofascial flap is a widely used material in interpositional arthroplasty. The temporalis myofascial tm is an important reconstructive flap in palate. The temporalis muscle flap is a versatile and reliable myofascial regional flap that. A large, bulky muscle and subcutaneous fat are characteristic of a free flap with microvascular anastomosis. Keeping the parameters of reconstruction in mind it is ideal to reconstruct the maxillary defect with either the free flaps or the regional flaps.
1382 1000 331 139 1123 878 107 483 1507 533 1242 775 708 1025 260 946 645 964 944 1249 290 861 385 1061 301 730 249 1105 166 1471 653 344 1062 1494 492 567