Anatomy of the middle temporal vein: implications for skull-base and craniofacial reconstruction using free flaps.

Abstract

Finding appropriate recipient veins for free flap reconstruction in the adjacent temporal region is sometimes difficult when performing skull base or craniofacial reconstruction because there is a limited number of recipient veins in the temporal region compared with the neck. The authors used cadaver dissection to evaluate the viability of the middle temporal vein as a recipient vein in the temporal region. The authors examined the characteristics and landmarks of the middle temporal vein in 60 sides of 30 cadavers. Its existence, caliber size, distribution pattern, and landmarks for dissection were measured. The middle temporal vein was located beneath the superficial layer of the deep temporal fascia and joined the main trunk of the superficial temporal vein. The vein was identified in all specimens, and its mean caliber was 1.88 mm. It was classified into four representative distribution patterns. According to the distribution pattern, the middle temporal vein provided one recipient vein without exception, and only 13 percent of middle temporal veins could provide two recipient veins. According to landmarks, the middle temporal vein runs approximately along the line between 52 mm lateral from the bony lateral canthus and 12 mm medial from the external auditory canal. The mean distance between the middle temporal vein and the temporal branch of the facial nerve was 13 mm. The middle temporal vein can provide one recipient vein of adequate caliber in the temporal region. In addition, it can be easily localized, without damaging the facial nerve, by means of incision according to the landmarks described in this study.