Pedicled Temporalis Muscle Flap Research Articles

Anteriorly pedicled deep layer of temporalis muscle flap for disc replacement after temporomandibular discectomy

ObjectiveAn anteriorly pedicled temporalis muscle flap has a functional advantage for temporomandibular (TMJ) joint reconstruction. However, the greater thickness of the flap for disc replacement after discectomy might cause several postoperative complications including malocclusion. The temporalis muscle can be split into the thin superficial and thick deep layers; they are separated by a thin fatty layer. Therefore, we developed the modified anteriorly pedicled temporalis muscle flap using the deep layer of the temporalis muscle, which has a suitable size for the TMJ space after discectomy without losing the functional advantage. MethodsThe procedure was applied to three patients who underwent discectomy for the treatment of synovial osteochondromatosis. They were followed up from preoperatively to more than 1 year postoperatively. ResultsNo significant postoperative complication were observed in all patients. Additionally, all patients obtained normal jaw function without malocclusion from immediately after the surgery. ConclusionThis technique offers some advantages in disc replacement after discectomy.

The 'Maxillary Pull-through' Technique: A Minimally Invasive Endoscopic-Assisted Approach to Nasal Septum Neoformations with Maxillary Bone Infiltration.

Description and validation of a surgical technique. En-bloc maxillectomy with removal of the nasal septum is a rare procedure; preservation of the nasal bones and integrity of the alveolar ridge is even rarer. These procedures traditionally required a combined transfacial-transoral approach based on lateral rhinotomy. We describe a combined endoscopic transnasal-transoral approach for treatment of nasal septal malignancies that involve the hard palate. Excision of malignant tumours arising from the nasal septum was achieved in 4 patients using a transnasal-transoral endoscopic approach. Using 4-mm optics angled at 0° and 30°, the septum was freed from the ethmoid and removed en-bloc with the hard palate, by pulling the septum down through the hard palate. Of the 4 patients, 2 underwent complete removal of septal chondrosarcomas, one removal of a sinonasal undifferentiated carcinoma and one removal of a mucoepidermoid carcinoma. In two cases, the palatal mucosa was spared and repositioned to restore separation between the nose and oral cavity. The remaining two cases underwent complete resection of the hard palate; one palate was reconstructed using a pedicled temporalis muscle flap and the other by employing an obturator. No infection was encountered. Partial ethmoidectomy was performed in all four cases. The mean hospital stay was 5 days. All patients are free of disease after a mean follow-up of 4 years (range: 2-7 years). Our new approach allows for minimally invasive resection of nasal septal malignancies that extend to the palate. Our maxillary pull-through technique is a valuable new surgical procedure for malignant pathologies of the nasal septum; the only drawback is that endoscopic surgery has a steep learning curve.

A case study of post-auricular persistent mastoid cutaneous fistula closure by anteriorly based temporalis muscle flap and tempero-mastoid fascio-cutaneous-periosteal flap

<p class="abstract">Post-auricular cutaneous mastoid fistula (PAMCF) is a rare complication of chronic otitis media (COM), following complicate mastoid surgery and very rarely following congenital cholesteatoma. The failure rate with simple closure is high due to necrotic skin edges. Therefore several techniques for the closure of this fistula have been described. Post aural fistula after canal wall down (CWD) mastoidectomy can be successfully treated by fistula tract excision and obliterating the mastoid cavity. A 45 year old woman presented with discharging PAMCF, 10 years following radical mastoidectomy surgery. It was due to non-compliance of the patient, as she had not gone for follow up for 10 year following radical mastoidectomy. The temporo-mastoid fascio-cutaneous-periosteal advancement flap is effective for proper closure of the fistula and obliteration of the cavity by conchal cartilage along with anteriorly based vascularised pedicled temporalis muscle flap to ensure the viability of the flap and preventing the necrosis of the skin edges, henceforth the recurrence of the fistula.</p>

Functional and aesthetic outcomes of pedicled temporalis muscle flap for mesostructure reconstruction

The purpose of this work is to analyse the soundness of the Temporalis Muscle Flap as a safe and reliable flap to restore the aesthetic and functions of the facial mesostructure after its partial resection.Subjects were selected retrospectively and were invited to come to our outpatient clinic. Here, subjects completed a clinical evaluation in which the medical examiners evaluated the aesthetic outcome, the phonation, the ocular motility and the swallowing.Twenty-two subjects were enrolled in this study and completed the clinical evaluation. The mean value of the score obtained for the aesthetic outcome was 2.91 ± 0.92, slightly less than good. The VHI-30 questionnaire for voice evaluation obtained a mean score of 22.5 ± 11.5, pointing out minor voice problems. The mean value of the P-score evaluated during Fiberoptic Endoscopic Evaluation of Swallowing was 4.64 ± 0.95, highlighting the near absence of endoscopic signs of dysphagia. On the evaluation of ocular function, only one subject showed an inferior displacement of his right eyeball without vertical diplopia.The Temporalis Muscle Flap is a safe and reliable flap that can be used to reconstruct numerous surgical defects of the maxilla, giving an excellent recovery of physical aspect, phonation, and swallowing.

Pedicled Temporalis Muscle Flap for Craniofacial Reconstruction: A 35-Year Clinical Experience with 366 Flaps.

In the past 130 years, the temporalis muscle flap has been used for a variety of different indications. In this age of microsurgery and perforator flaps, the temporalis muscle flap still has many useful applications for craniofacial reconstruction. Three hundred sixty-six temporalis muscle flaps were performed in a single center between 1978 and 2012. The authors divided the cases into two series-before and after 1994-because, after 1994, they started to perform free flap reconstructions, and indications for reconstruction with a temporalis muscle flap were changed RESULTS:: In the series after 1994, flaps were most commonly used for reconstruction of defects in the maxilla, mandible, and oropharynx, in addition to facial reanimation and filling of orbital defects. Complications included total flap necrosis (1.6 percent) and partial flap necrosis (10.7 percent). The rate of material extrusion at the donor site decreased after porous polyethylene was uniformly used for reconstruction from 17.1 to 7.9 percent. The pedicled temporalis muscle flap continues to have many applications in craniofacial reconstruction. With increasing use of free flaps, the authors' indications for the pedicled temporalis muscle flap are now restricted to (1) orbital filling for congenital or acquired anophthalmia; (2) filling of unilateral maxillectomy defects; and (3) facial reanimation in selected cases of facial nerve palsy. Therapeutic, IV.

Anteriorly Pedicled Wide Temporalis Muscle Flap With the Minimum Zygomatic Osteotomy Technique for Post-Discectomy Temporomandibular Joint Arthroplasty

An anteriorly pedicled temporalis muscle flap has been shown to be a suitable interpositional material for the treatment of ankylosis and post-discectomy arthroplasty. The passage of the wide flap beneath the zygomatic arch into the joint space can be difficult owing to its bulk, causing excessive trauma to the vascularized pedicle. We describe the use of minimum zygomatic osteotomy without fixation for the passage of an anteriorly pedicled wide temporalis muscle flap for post-discectomy arthroplasty.

Extensive pneumocephalus extending into the lateral ventricles from a brain abscess: an intracranial complication of cholesteatoma

We report the case of a patient with extensive pneumocephalus extending into the lateral ventricles from a brain abscess arising from a cholesteatoma-induced defect in the skull base. A 70-year-old man with cholesteatoma presented with right-sided otalgia, otorrhoea and progressive headaches. Computed tomography showed a tegmental defect (approximately 2 × 2 cm) at the right mastoid antrum. A T1-weighted, gadolinium-enhanced magnetic resonance imaging scan showed pneumocephalus in both lateral ventricles, which was directly connected to the mastoid cavity via a brain abscess and a bone defect in the skull base. Radical mastoidectomy was performed to remove the cholesteatoma. The roof of the mastoid cavity was covered extensively with fascia and a pedicled temporalis muscle flap. One week post-operatively, computed tomography and magnetic resonance imaging showed no pneumocephalus. Pneumocephalus arising from a cholesteatoma-induced brain abscess and extending into the lateral ventricles is an important entity, with an atypical appearance on computed tomography and magnetic resonance imaging.

Intraoral Transposition of Pedicled Temporalis Muscle Flap Followed by Zygomatic Implant Placement

Despite the recent advances of sophisticated reconstructive surgical techniques, management of maxillectomy defects continues to be challenging. For a selected group of patients, who cannot sustain a sophisticated microsurgical reconstructive procedure, a prosthetic obturator is indicated to separate the oral cavity from the sinonasal cavities. After the development of the osseointegration concept, dental implants have proven to be indicated for the rehabilitation of patients who underwent maxillectomy. Recently, surgeons can use a computer-assisted software package, which enables them to insert implants after a detailed analysis of the residual bone. For some patients with limited amount of residual maxillary bone, unusual surgical sites such as the zygomatic complex have been tested. We introduce a successful 2-step surgical procedure using a pedicled temporalis muscle flap and zygomatic implant placement to reconstruct a maxillary defect after oncological resection.

New Method for Maximum Mobilization of Temporalis Muscle Flap

Pedicled temporalis muscle flap presenting a good flap for closing large craniofacial defects. Careful surgeons usually do not mobilize temporalis muscle flap enough to make appropriate use, fully closure, especially if defect exceeds the median line. Temporalis flap was used in 16 patients, ages ranged between 12 and 76. In all cases defect reconstruction was done by useing new method of extending standard temporal muscle flap. During surgical procedure it is very important to keep periosteal elevator in close contact with the bone. Then, there is no risk for pedicle injury. After vascular pedicle is identified elevating temporal muscle has to be continued by releasing the muscle insertion from the coronoid process. By this way, flap length and arc of rotation is increased. The flap remained viable in all instances. Most of the patients experienced no perioperative complications. There was no major complications or mortality as a result of performed procedures. With this division, flap length was increased at least 2 cm wich is enough for covering defects crossing the midline. Instead of using bilateral temporalis muscle flaps for defect closure, unilateral is sufficient. With this extension of the pedicle length now rotation point is not at the level of the zygomatic arch but lower part mandibular neck.

An Oculoplastic Use for the Temporalis Muscle Flap

ABSTRACTPurpose: To report a novel method of repairing a large periorbital defect with exposed bone, using a pedicled temporalis muscle flap and split thickness skin graft. Methods: Interventional case note review with clinical photographs, computerised tomography (CT) imaging, intra-operative photographs and histology. Results: A 77-year-old man presented with an extensive neglected ulcerating lesion extending from the left lateral canthus to the tragus of the left ear. An incisional biopsy of the 15 cm lesion confirmed the clinical diagnosis of an invasive squamous cell carcinoma. A CT scan demonstrated the tumour depth and there were no infra-temporal fossa or intra-orbital extensions or associated lymphadenopathy. A wide surgical excision was performed which resulted perioperatively in a large area of exposed zygomatic and temporal bone. A pedicled temporalis muscle flap was rotated to cover the exposed bone and therefore allow placement of a split thickness skin graft. At 3 months' follow-up the graft is viable and the surgical rehabilitative result is satisfactory. Conclusions: A pedicled temporalis muscle flap and split thickness skin graft is a good one-stage reconstruction technique when faced with a large area of exposed bone. The temporalis muscle provides a suitable recipient site for a split skin graft and enhances its chances of survival. This technique, to our knowledge, had not previously been reported in the literature.

Oncocytoma of the eyelid: An aggressive benign tumor

ObjectiveThe authors report the case of an 83-year-old patient with a benign oncocytoma of the inferior eyelid. DesignInterventional case report. InterventionTreatment consisted of a large orbital exenteration followed by reconstruction with a pedicled temporalis muscle flap. Main outcome measuresHistologic evaluation and clinical follow-up were measured. ResultsAfter a year of follow-up, there was no sign of local recurrence. ConclusionsOncocytomas, even if benign, must be considered as very aggressive tumors and treated accordingly.

Cochlear implantation in the presence of chronic suppurative otitis media.

Nine patients are presented who underwent cochlear implantation in the presence of chronic suppurative otitis media. Four had a simple tympanic membrane perforation, four had a pre-existing mastoid cavity and one had cholesteatoma in the ear chosen for implantation. Patients with a simple perforation had a staged procedure with myringoplasty followed by cochlear implantation after an interval of three months. Patients with cholesteatoma or with an unstable mastoid cavity were also staged. A mastoidectomy or revision mastoidectomy was performed with obliteration of the middle ear and mastoid using a superiorly pedicled temporalis muscle flap and blind sac closure of the external meatal skin. After a further six months a second stage procedure was performed to confirm that the middle-ear cleft was healthy and to insert the implant. Patients presenting with a stable mastoid cavity underwent obliteration of the cavity and implantation of the electrode as a one-staged procedure. To date there have been no serious problems such as graft breakdown, recurrence of disease or implant extrusion, and all patients are performing well.

Incidence of Attic Retraction After Staged Intact Canal Wall Tympanoplasty for Middle Ear Cholesteatoma

Incidence of retraction pocket and recurrent cholesteatoma in the attic after surgery for middle ear cholesteatoma using the staged intact canal wall technique were investigated in 95 ears of 91 patients, all of which had various degrees of bone defect in the tympanic scutum. Surgical procedures employed in the second stage for prevention of attic retraction were classified into three types: Type I, no scutumplasty; Type II, scutumplasty; Type III, scutumplasty plus mastoid obliteration. In 83 ears followed up for more than 1 year after the second stage, such retraction troubles occurred in 2 of 13 ears (15%) in Type I, 8 of 20 ears (40%) in Type II, and 24 of 50 ears (48%) in Type III. Incidence of retraction troubles was higher in Types II and III, probably because these procedures were indicated in ears with large scutum defects. Dislocation and atrophy of the graft materials, together with bone resorption around the bone defect were the main reasons for failure in scutumplasty. Dysfunction of the eustachian tube and traction of the eardrum by the scar tissue behind it may have also contributed to attic retraction. Mastoid obliteration with small blocks of hydroxyapatite was more effective in prevention of retraction troubles than that with pedicled temporalis muscle flap.