Technique of Temporoparietal Fascia Flap in Ear and Lateral Skull Base Surgery

Abstract

The temporoparietal fascia (TPF) is a distinct anatomic layer of the lateral scalp with a defined blood supply. The TPF flap has desirable properties for otologic surgery: high malleability, distinct vascularity, and close proximity to the temporal bone. This article describes our technique for preserving the TPF in approaches to the temporal bone and its subsequent use in otologic reconstructive surgery. A retrospective review of the senior author's personal database was undertaken over a 6-year period where a TPF flap was used. The indication for surgery, type of surgery, time taken for cavity healing, complications, and length of follow-up were recorded. Sixty-five TPF flaps were performed for ear and lateral skull base reconstructive operations. Indications for surgery included cholesteatoma, chronic otitis media, cerebrospinal fluid fistula, and meningoencephalocele. Cholesteatoma and chronic otitis media accounted for 88% of the cases (n = 57). Most (98%, n = 50) of the mastoidectomy cases underwent a posterior based flap. All mastoid cases were epithelialized at 6 weeks. Complications encountered and discussed were a mastoid-cutaneous fistula, mastoid hematoma, and canal stenosis (5%; n = 3). With appropriate technique and indications, the TPF flap is an important reconstructive option after ear and lateral skull base surgery.