The temporalis muscle flap comprises the temporalis muscle. The temporoparietal fascia tpf is an extension of the subcutaneous musculoaponeurotic system smas inferiorly and the galea aponeurotica superiorly. In the series after 1994, flaps were most commonly used for reconstruction of. The temporal muscle fascia lies deep to the tpf over the temporalis muscle. There was 1 partial flap necrosis that occurred in a patient who had previously received radiation therapy and who healed secondarily without sequelae. The required area of skin and tissue is moved without interrupting the blood supply.
This graft is harvested from the contralateral scalp. Twostage temporalis flap reconstruction for facial paralysis. 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. Split temporalis muscle flap anatomy, vascularization and. Buccinator flap as a method for palatal fistula and vpi management. 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.
Twostage temporalis flap reconstruction for facial. This text describes surgical procedures, techniques and approaches used in major flap transfers for reconstructive headandneck surgery. The temporalis muscle flap can be designed to encompass various tissue types. Versatility of temporal muscle and fascial flaps journal of plastic. At the fall meeting of the american academy of facial plastic and reconstructive surgery held in chicago, ben d. 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. 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. The temporalis osteomyoperiosteal flap its blood supply and. In the series after 1994, flaps were most commonly used for. 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. The temporalis osteomyoperiosteal flap its blood supply. The temporalis muscle flap for palate reconstruction. It is an axial flap based on the anterior and posterior deep temporal arteries. Jul 06, 2012 temporal muscle flap is especially easily predestinated for applying in reconstructive procedures of maxillafacial regions.
Evolution golovine 1898 reconstruction after orbital exenteration. The aim of this report is to present a case of bilateral temporalis and masseteric muscles hypertrophy treated surgically. Dec 11, 20 the temporalis flap in otolaryngology for more than 20 years, broadcastmed has been innovating digital strategies for healthcare organizations. A novel technique allows reconstruction of both the upper and lower. Reconstruction of midfacial defects using temporalis. Surgical treatment of bilateral temporalis and masseteric. The temporalis flap remains as one of the reconstructive options for patients with facial paralysis. The anatomy, surgical technique, indications and results are described for each flap, using seven representative cases. Clinic of plastic reconstructive and aesthetic surgery, public hospital, mus, turkey. Use of the temporalis muscle flap in the dog use of the temporalis muscle flap in the dog tomlinson, james. 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.
Temporalis flap for the maxillary defect reconstruction. The alt flap is a versatile and reliable platform for softtissue volume restoration while also providing access to fascia and motor nerves without introducing additional morbidity. Temporalis muscle flap operative techniques in otolaryngology. 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. Efficacy of temporalis myofascial flap as an interpositional. The new reconstruction technique in the treatment of the. The osseous mass is resected and the joint reconstructed by autogenous bone grafts or a total joint prosthesis. Difficulty of reconstruction of the eyelids arises from the need to reconstruct different supporting and covering structures in a single operation. Its values are axial vascularization, location close to reconstruction site, easy harvest and good results with its use. Bhanu prakash usmle, fmge and neet pg 16,856 views. Temporalis muscle flap for the reconstruction orofacial defects case reports indian dental academy leader in continuing dental education. Department of plastic reconstructive and aesthetic surgery, dokuz eylul university, faculty of medicine, izmir, 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.
Atlas of regional and free flaps for head and neck. It is usually divided during elevation of the flap, forming and insensate are on the lateral scalp. Like the tpff, the tmf is a reliable, myofascial flap that was also described more than a century ago. The temporalis muscle flap in reconstruction of intraoral. Once the epithelialization is complete, the new mucosal surface covering the muscle is indistinguishable from surrounding mucosa 10. 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.
It provides a thin sheet of vascularized fascia based on the superficial temporal artery and vein. About three to six weeks later, an ipsilateral temporalis muscle and fascia transfer is made to this previously placed graft. The temporalis muscle flap illustrated in this video is commonly used as a reliable method to reconstruct palate defects. To increase the thickness of the vascular pedicle, we discussed long vascularized pedicle flaps based on temporalis muscle and its superficial and deep fascial layers. Temporalis flap for the maxillary defect reconstruction youtube. 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. 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. Pdf the temporalis muscle flap for palate reconstruction. In the years 19962010 we treated 10 patients with malignant neoplasms of maxillofacial region. 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. The temporalis muscle flap comprises the temporalis muscle, with or without the overlying temporalis fascia. 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. Treatment of temporomandibular joint ankylosis with. 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.
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. 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. Seventeen lower eyelids were evaluated as mild, 12 were as moderate, and 9 were as severe ectropion. A practical approach provides comprehensive, stepbystep instruction for flap raising and insetting for the head and neck region. It presents descriptions of anatomy and anatomical. Aug 09, 2017 temporal fascia medical animation gross anatomy of head and neck, dr g bhanu prakash duration. Ideal for oral and maxillofacial surgeons, facial plastic surgeons, and head and neck surgeons, the book serves as a useful guide to planning reconstructive. The vascular supply is the deep temporal artery, which originates from the internal maxillary artery fig. The anatomy and surgical technique of the temporalis myofascial flap has been well documented. Jun 14, 2016 the temporalis muscle is found deep to the temporalis muscle fascia. The versatility of temporalis myofascial flap in maxillo. Decompressive craniectomy bone flap hinged on the temporalis. 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 temporoparietal fascia flaps is supplied by the superficial temporal artery and vein.
We performed posterior lamellar eyelid reconstruction with. 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 authors mention that they discuss a novel technique of skull base reconstruction using a vascularized. Anatomical basis and results of the facial artery musculomucosal flap for oral reconstruction. Click download or read online button to get atlas of regional and free flaps for head and neck reconstruction book now. 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 temporalis muscle flap provides abundant well vascularized tissue and has been described for head and neck reconstruction. However, its use for repair of skull base defects is less commonly reported. Temporalis myofascial flap tmf and immediate soft tissue. Dec, 2019 buccinator flap as a method for palatal fistula and vpi management. I read the article by zeiler and kaufmann 15 with interest zeiler fa, kaufmann am. A bmf was raised intraorally and rotated on its posterior neurovascular pedicle into the defect.
Modified temporalis muscle flap for eyelid reanimation. For more than a century, the temporalis muscle has been used for facial reconstructions. A novel technique allows reconstruction of both the upper and lower eyelids using the temporalis muscle in combination with local flaps. Reconstruction of temporomandibular joint ankylosis with temporalis myofascial flap in a cat.
Indications the anterior pericranial and galeofrontalis flaps have been used extensively for anterior skull base and craniofacial reconstruction. 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. Temporalis muscle hypertrophy is a rare clinical entity and only a few cases are reported. Temporal fascia medical animation gross anatomy of head and neck, dr g bhanu prakash duration. Temporal muscle flap is especially easily predestinated for applying in reconstructive procedures of maxillafacial regions. Simultaneous anterolateral thigh flap and temporalis tendon. Temporalis muscle flap and temporoparietal fascia flap ento key. Mar 19, 20 for more than a century, the temporalis muscle has been used for facial reconstructions. Trauma, previous surgery, irradiation, or carotid occlusion may jeopardize the integrity of the temporoparietal fascia flap. Temporalis muscle flap for the reconstruction oro facial. Available in a variety of sizes, pockets, closures, materials, expansions, and with preprinted and customizable tabs. Temporalis myofascial flap transfer into the oral cavity without. The present study was performed to determine the postoperative outcomes of patients following frontotemporal depression. The pericranial flap is reflected forward and covered with a wet lap sponge until it is needed.
However, it can result in temporal hollowing, which causes significant craniomaxillofacial asymmetry and esthetic deformity. Use of the temporalis muscle flap in the dog, veterinary. Jun 04, 2018 although the temporoparietal fascia flap is highly vascular and reliable, prior injury to the temporal field could result in flap necrosis. 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. Efficacy of temporalis myofascial flap as an interpositional graft material in the management of tmj ankylosis. The versatile use of temporoparietal fascial flap cenk demirdover1, baris sahin2 3, haluk vayvada1, hasan yucel oztan 1.
The temporalis muscle flap and temporoparietal fascial flap. Jan 12, 2015 the temporalis flap remains as one of the reconstructive options for patients with facial paralysis. All the flaps of temporal muscle that were used for reconstructing eye sockets incorporated with no local reaction. Anterior pericranial and galeofrontalispericranial flaps. Temporalis muscle flap for reconstruction of skull base. The temporalis muscle flap tmf is a valuable reconstructive technique utilized in a variety of challenging defects. Temporal muscle flap in reconstruction of maxillofacial.
Presents our experience in reconstruction of postsurgical defects with use of temporal muscle flap. Alternatively, we used reverse deep temporal fascia flap in another case to reach the upper medial part of the orbit. Pedicled temporalis muscle flap for craniofacial reconstruct. The operation is a twostaged procedure where free temporalis fascial graft is placed through an external incision around the oral commissure. 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. Orthodromic temporalis tendon transfer additionally provides for immediate facial symmetry and restoration of oral competence with early cornerofmouth movement. Reconstruction of temporomandibular joint ankylosis with.
Simultaneous anterolateral thigh flap and temporalis. Once the coronal flap is raised, the pericranial flap is elevated off of the calvarium down to approximately 1 cm above the supraorbital rims. In conclusion, the described technique is anatomically. Care must be taken not to disrupt the deep branches of the supraorbital and supratrochlear vessels. Temporalis muscle flap for reconstruction of skull base defects. In these cases, the muscle may be employed to restore dynamic function to the paralyzed face. Vascularized rotational temporal bone flap for repair of. Temporalis muscle flap heals with secondary epithelialization, unless the flap is traumatized by occluding teeth. Pterional craniotomy is a useful approach for the treatment of a variety of intracranial pathologies. The flap adds protection and security and allows you to take your files wherever you go. 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 fascia is superficial to the deep temporal fascia, and just below the hair follicles of the scalp.
In this study, the temporalis superficial fascia flap was evaluated as an interpositional material after condylectomy. Nov 01, 20 basic principles of local flap in plastic surgery 1. Cadaver dissections, injection studies, and histological. The temporal muscle, also known as the temporalis, is one of the muscles of mastication. Vascularized rotational temporal bone flap for repair of anterior skull base defects. 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.
More often, it presents a bilateral involvement and is usually associated with masseteric hypertrophy 3. Cosmetic reconstruction of frontotemporal depression using. The flap is plane, easy to form and contrary to skin flaps has no hair. Cadaver dissections, injection studies, and histological investigations were performed. 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.
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. Facial artery is incorporated in the base of the flap. Temporal muscle flap in reconstruction of maxillofacial tissues. 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. 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. This thin, pliable, and highly vascularized flap, accepts skin grafts on both sides. A technique for onestage reconstruction for bony and soft tissue repair after subtotal bilateral maxillectomy is reported.
Complete epithelialization gets over in 4 to 6 weeks 2, 10, 15. 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. Anterior craniofacial resection with formal anterior bifrontal craniotomy. Temporalis muscle flap and temporoparietal fascia flap. Temporalis myofascial flap for primary cranial base. Temporalis muscle flap vula university of cape town. A wide variety of file folder with flap options are available to you, such as folder, wallet, and bag. Kim college of veterinary medicine, chonbuk national university, jeonju, republic of korea abstract. Reconstruction of intraoral defects using facial artery musculomucosal flap. The benefit of a musculocutaneous flap over a pure muscle flap. A temporalis muscle flap is developed that includes the overlying temporalis fascia and the underlying pericranium from the most inferior horizontally originated fibres of the temporalis muscle approximately 2 cm in width and about 5 cm in length, at this point with the flap elevated and the pericranium and the temporalis fascia are sewn together to form a muscle sandwich. Dec 21, 2019 buccinator flap as a method for palatal fistula and vpi management. Keep your desk, work surface or countertop organized with a smead expanding file.
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