Temporal Fossa Research Articles

SIMULTANEOUS REMOVAL OF THE NEURINOMA OF THE TRIPLE NERV, LOCALIZED IN THE BACK, MIDDLE, AND SECULAR PITS. CLINICAL OBSERVATION AND REVIEW OF LITERATURE.

The aim of the study is to consider and show the possibilities of methods for surgery of skull base tumors using the example of successful surgical treatment of a patient with widespread trigeminal neuroma located in the posterior, middle and temporal fossae, as well as to analyze international scientific experience on this issue.
 Materials and methods. In February 2020, a 60-year-old patient with widespread trigeminal neuroma on the left was admitted to the Federal Scientific-Clinical Center of FMBA of Russia in February 2020. After additional examination and preoperative preparation, a planned operation was performed - osteoplastic orbitozygomatic trepanation of the skull, microsurgical removal of the tumor through subtemporal transcavernous access. A good postoperative clinical result was obtained. An analysis of the available scientific literature on this problem is carried out.
 Results. In the postoperative period, pain and neurological symptoms, hemifacial spasm completely regressed. 1.5 months after the operation, the tumor was totally removed in the control images. In the course of the analysis of available foreign and domestic literature, 65 observations of trigeminal tumors with extracranial growth were found, the total removal of which was performed only in 20% of patients.
 Conclusion. Despite the extreme complexity of the pathology, the operation through the orbitozygomatic subtemporal transcavernous access allows you to completely remove the common and giant trigeminal neuromas with a good functional result.

Optimal indications and limitations of endoscopic transorbital superior eyelid surgery for spheno-orbital meningiomas.

Spheno-orbital meningiomas (SOMs) are complicated tumors that involve multiple structures at initial presentation, such as the orbit, temporalis muscle, sphenoidal bone, cavernous sinus, and temporal or infratemporal fossa. The infiltrative growth and complexity of this type of meningioma make total resection impossible. In this study, the authors evaluated the surgical outcome of the endoscopic transorbital approach (eTOA) for SOM. In addition, they identified optimal indications for the use of eTOA and analyzed the feasibility of this approach as a minimally invasive surgery for SOMs of varying types and locations at presentation. Between September 2016 and December 2019, the authors performed eTOA in 41 patients with SOM with or without orbital involvement at 3 independent tertiary institutions. The authors evaluated the surgical outcomes of eTOA for SOM and investigated several factors that affect the outcome, such as tumor volume, tumor location, and the presence of lateral orbitotomy. Gross-total resection (GTR) was defined as complete resection of the tumor or intended subtotal resection except the cavernous sinus. This study was undertaken as a multicenter project (006) of the Korean Society of Endoscopic Neurosurgery (KOSEN-006). There were 41 patients (5 men and 36 women) with a median age of 52.0 years (range 24-73 years). Twenty-one patients had tumors that involved the orbital structure, while 14 patients had tumors that presented at the sphenoidal bone along with other structures, such as the cavernous sinus, temporal fossa, and infratemporal fossa. Fifteen patients had the globulous type of tumor and 26 patients had the en plaque type. Overall, GTR was achieved in 21 of 41 patients (51.2%), and complications included CSF leaks in 2 patients and wound complications in 2 patients. Multiple logistic regression analysis showed that the en plaque type of tumor, absence of lateral orbital rim osteotomy, involvement of the temporal floor or infratemporal fossa, and involvement of the orbit and medial one-third of the greater sphenoidal wing were closely associated with lower GTR rates (p < 0.05). Multivariate analysis revealed that the en plaque type of tumor and the absence of lateral orbital rim osteotomy were significant predictors for lower GTR rate. The en plaque type of SOM remains a challenge despite advances in technique such as minimally invasive surgery. Overall, clinical outcome of eTOA for SOM was comparable to the transcranial surgery. To achieve GTR, eTOA is recommended, with additional lateral orbital rim osteotomy for globulous-type tumors, without involving the floor of the temporal and infratemporal fossa.

A rare case of epidermal inclusion cyst: an unusual complication of ear surgery

BackgroundEpidermal inclusion cysts are common tumours of the hand in industrial workers caused by entrapment of epidermal elements within the dermis. They are unusual in the head and neck region more so in the temporal region.Case presentationWe present a 27-year-old man with a 3-month history of a slow-growing swelling in the left temporal region. He had a history of chronic otitis media and underwent an end-aural tympanomastoid surgery 5 years earlier. Physical examination revealed a 5 × 3 × 2.5 cm cystic globular minimally tender mass in the temporal fossa along with squamous active otitis media with bony erosion of the outer attic wall. High-resolution computed tomography of the left temporal bone revealed otomastoiditis with erosion of the scutum; ossicles were not identified. We hereby describe the diagnostic challenge and the plan of management of this lesion.ConclusionsEpidermal inclusion cyst must be considered in the differential diagnosis of temporal fossa lesions especially in patients with a prior history of ipsilateral tympanomastoid surgery.

A Systematic Literature Review of the Middle Temporal Vein Anatomy: 'Venous Danger Zone' in Temporal Fossa for Filler Injections.

Treatment of a sunken appearance of the temporal region using injectable fillers is a popular procedure. The temporal fossa has very complex anatomy due to multiple vessels running in the different tissue layers. A severe complication in the form of non-thrombotic pulmonary embolism (NTPE) can occur as a result of an inadvertent injection in the middle temporal vein (MTV) while performing temporal fossa filler procedures. Therefore, in-depth knowledge and understanding of the MTV anatomy are essential for successful and safer injectable procedures of the temporal fossa. While there have been many studies to describe the arteries in this region, there is limited information about the location and course of the middle temporal vein. This literature review is aimed at providing detailed information about the course, depth, and size of the MTV to help aesthetic practitioners in performing safer temporal fossa filler injections. This information is imperative to delineate the 'venous danger zone' in the temple region. The preferred reporting items for systematic reviews and meta-analyses guidelines were used for this review. A literature search was performed to find the articles providing details about the MTV anatomy and the measurements related to its course and size. A review of the literature showed that the MTV displays a consistent course and depth in the temporal region, with high variability in its diameter. The middle temporal vein width varied between 0.5 and 9.1mm in various studies. The middle temporal vein receives many subfascial tributaries from the surface of the temporalis muscle, and for most of its course runs in the fat pad enclosed between superficial and deep layers of the deep temporal fascia. A 'venous danger zone,' in the interfascial planes of the temporal fossa, which contain the main part of the MTV and its tributaries, has been proposed in this paper. The temporal fossa filler procedures need great caution, and knowledge of the depth and course of the MTV is essential for avoiding NTPE. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Temporal volume increase after reduction of masseteric hypertrophy utilizing incobotulinumtoxin type A.

BackgroundTreating the lower face with neuromodulators and targeting the masseter muscle can reduce masseteric hypertrophy but can also change the facial shape. A novel observation after the treatment of the masseter muscle with incobotulinumtoxin Type A was the increase in temporal volume.AimObjectively assess temporal volume increase following treatment of masseteric hypertrophy using incobotulinumtoxin Type A.MethodsNine female patients with a mean age of 35.11 years ± 9.1 [Asian (11.1%) and Caucasian (88.9%)] were treated with incobotulinumtoxin Type A for masseteric hypertrophy. Masseteric prominence and temporal volume were assessed by two independent raters, and temporal fossa volume was measured via 3‐dimensional volumetric imaging.ResultsIndependent of the neuromodulator injection technique (ie, single‐injection versus multi‐injection), a reduction in masseteric hypertrophy occurred represented by a decrease in the masseter prominence scale. In addition, the treatment resulted in a significant improvement of the temporal volume scale and an increase in the measured volume of the temporal fossa. None of the presented measurements were statistically significantly different between the two utilized injection techniques.ConclusionsThis study supports using a full‐face approach when performing aesthetic treatments. Anatomical concepts can help to guide treatments: the compensatory increase in temporalis function after masseter muscle treatment resulted in an increased in temporal fossa volume. The findings presented herein should not be considered as a new concept for treating the temporal fossa but rather as an additional possibility for increasing the temporal volume.

Analysis of Clinical Significance of the Pterygospinous and Pterygoalar Bars.

Presence of ossified structures at the skull base near the sphenoid bone in the infra temporal fossa are clinically significant. We studied the incidence of pterygospinous bar (PSB) and pterygoalar bar (PAB) in 140 dried human skulls. The incidence of pterygospinous bar was 22% and pterygoalar bar was 11%. An unusual large pterygspinous foramen was present in one of the skulls on the left side. Clinical significance of these bars are reviewed.

Expanded endoscopic endonasal transpterygoid transmaxillary approach for a giant trigeminal schwannoma.

Atypical trigeminal schwannomas (ATSs) are notorious for their ability to invade the skull base. An expanded endoscopic endonasal approach (eEEA) provides direct access to the tumor with no need for cerebral retraction or manipulation of neurovascular structures. Herein, we present a case of a large temporal fossa extradural lesion with secondary invasion of the sella, clivus, and temporal and infratemporal fossae in a 49-year-old male with severe vision loss. A transpterygoid transmaxillary approach was performed. Gross-total removal was achieved and pathology revealed the diagnosis of ATS. Visual function fully recovered in the right side and the patient has been uneventfully followed since surgery.The video can be found here: https://youtu.be/6pSwdYsN9hk.

3D Muscle Fiber Architecture of Avian Jaw Muscles and their Significance for Avian cranial functional morphology evolution

Birds evolved a diversity of head shapes, feeding behaviors and jaw muscles which drive the feeding apparatus. However, capturing the anatomical and functional diversity of these muscles remains challenging and we know little about how jaw muscles develop, function and evolve among lineages of the clade and this hampers our ability to understand skeletal tissue biology, joint function, and patterns of evolution in bird skulls. Here we use contrast imaging, 3D muscle fiber tracking and new data visualization methods to explore the morphology, architecture and functional significance of the jaw muscles of a sample of birds to highlight the potential of these approaches. First, we show differences in functional morphology of jaw muscles between a hatchling and adult Mallard duck (Anas platyrhynchos). Ducks show a marked change in adductor chamber shape during ontogeny including an elongated postorbital process, quadrate orbital process and retroarticular process along with a broad temporal fossa which likely track with changes in muscle function and cranial kinesis. Indeed, we found m. depressor mandibulae in baby and adult ducks shifts from a rostrocadual orientation to a more dorsoventral orientation that offers additional mechanical advantage to jaw opening and propalinal mandible movement as well as concomitant changes in the 3D resultant and pennation of other jaw muscle bellies. Second, we show differences between a long‐ and short‐faced, dabbling birds (mallard, green‐wing teal), long faced orthally‐biting bird (belted kingfisher) and a short‐faced, hard‐biting bird, the grey parrot (Psittacus erithacus). We expected position, architecture and biomechanics of homologous muscles to differ substantially between these avian species given their different behaviors and overall cranial morphology. Although some muscles showed marked differences in resultant and pennation, others, including protractor pterygoideus, the primary actuator of kinesis, were remarkably similar in morphology suggesting a mosaic of changes happening during avian evolution. Together, these new, 3D high fidelity anatomical data on jaw muscle functional morphology in birds will not only better illuminate ecomorphological evolution but also illustrate how other clades of birds and vertebrates adapt their muscle architecture to meet functional demands.

Ultrasound to Improve the Safety and Efficacy of Lipofilling of the Temples.

Autologous fat is known for a reliable and natural safety profile, but complications do occur-even serious vascular adverse events. The authors sought to examine doppler-ultrasound (DUS) imaging for the harvesting and subsequent facial implantation of autologous fat tissue. All patients underwent lipofilling treatment of the temporal fosse of the face. DUS examination was performed for preprocedural vascular mapping and imaging of previously injected (permanent) fillers. In addition, the injection of autologous fat was performed DUS-guided. Twenty patients (all female; mean age, 57.9 years; range, 35-64 years). DUS examination showed that 16 of the 20 patients (80%) had been injected with resorbable or nonresorbable fillers elsewhere in the past. The temporal artery could be visualized and avoided in all cases. An average of 1.1 cc of autologous fat was injected in the temporal fossa per side. One case of edema and nodules was described, but no other adverse events were reported. The utilization of DUS can add valuable information to a lipofilling procedure and should be considered an integral part of a safe lipofilling treatment.

Temporal Fat Pad Volume in Patients With Thyroid Eye Disease.

To determine whether thyroid eye disease (TED) is associated with a change in temporal fossa soft tissue volume. CT imaging studies were selected from patients with TED considering orbital decompression surgery and from an age-matched group of controls presenting to the Emergency Department for nontraumatic conditions requiring CT imaging. Measurements of the temporal fossa fat pad and soft tissue thickness were used as a proxy for volume and were performed using the zygomaticotemporal suture as a reference point. Categorical variables were described using frequencies and percentages, while continuous variables were described using medians and standard deviations. Chi-square tests were used to assess the relationship between gender and age group, while t-tests were used to examine the relationship between continuous variables and age group. A total of 56 CT scans were evaluated, including scans from 28 patients with TED and 28 controls. The following measurements were found to be significantly larger in the TED population: left fat pad measured 5 mm above the zygomaticotemporal suture (p = 0.012), right fat pad measured 15 mm above the suture (p = 0.005), right soft tissue measured 15 mm above the suture (p = 0.026), left fat pad measured 15 mm above the suture (p = 0.006), and the left soft tissue measure 15 mm above the suture (p = 0.032). Thyroid eye disease is associated with an increase in temporal fossa fat pad and soft tissue volume. These findings suggest that TED disease may produce pan-facial changes rather than changes confined to the peri-orbital region.

Expanded transnasal approaches to the skull base in the Middle East: Where do we stand?

ABSTRACTBACKGROUND: Endoscopic transnasal surgery has gained rapid global acceptance over the last two decades. The growing literature and understanding of anterior skull base endoscopic anatomy, in addition to new dedicated endoscopic instruments and tools, have helped to expand the use of the transnasal route in skull base surgery.OBJECTIVE: Report our early experience in expanded endoscopic transnasal surgery (EETS) and approach to skull base neoplasms.DESIGN: Descriptive, retrospective case series.SETTING: Major tertiary care center.PATIENTS AND METHODS: A retrospective case review was conducted at King Saud University Medical City between December 2014 and August 2019. Cases with skull base neoplasms that underwent EETS were included. EETS was defined as endoscopic surgical exposure that extended beyond the sellar margins (prechiasmatic sulcus superiorly, clival recess inferiorly, cavernous carotid lines laterally). Routine transsphenoidal pituitary neoplasms, neoplasms of sinonasal origin and meningoencephaloceles were excluded.MAIN OUTCOME MEASURES: Preoperative clinical assessment, imaging results, surgical approach, and hospital course were all retrieved from the patient electronic charts. Clinical follow-up, perioperative complications, and gross residual tumor rates were documented and reviewed.SAMPLE SIZE AND CHARACTERISTICS: 45 cases of EETS, 13 males and 32 females with mean age of 39.0 (17.7) years (range 2–70 years).RESULTS: The series comprised a wide range of pathologies, including giant pituitary adenoma (8 cases), meningioma (23 cases), craniopharyngioma (4 cases), chordoma (4 cases), optic pathway glioma (2 cases), epidermoid neoplasms (2 cases), astrocytoma (1 case), and teratoma (1 case). For the entire series, gross total resection was achieved in 25/45 operations (55.5%). Postoperative cerebrospinal fluid leak was the most common complication observed in 9 patients (20%) which were all managed endoscopically. Major vascular complications occurred in 2 patients (4.4%) and are described. Other complications are outlined as well. No mortality was observed.CONCLUSIONS: EETS to the skull base can be done with results comparable to traditional approaches. More work is needed to expand our experience, improve outcomes, and educate the public and medical community in our region about the usefulness of this approach.LIMITATIONS: Sample size and study design.CONFLICT OF INTEREST: None.

Outcome of Treatment in Locally Advanced Upper Alveolar Carcinoma Extending to Infra-temporal Fossa.

Squamous cell carcinoma of oral cavity has a high prevalence in our region. Upper alveolar cancers are uncommon but present with locally advanced disease extending to infra temporal fossa. The outcome of treatment in these tumors is poor. Surgery followed by adjuvant therapy is the mainstay of treatment. We are presenting a retrospective analysis of outcome of treatment in 20 patients with locally advanced (T4b) upper alveolar carcinoma treated by infra-structure maxillectomy with compartment resection of infra-temporal fossa and neck dissection followed by adjuvant radiotherapy or radiotherapy with chemotherapy. Study period was from 2013 to 2018. Minimum follow up was 12months and mean follow up 30months. 12 patients are alive and disease free, 6 patients had local recurrence and 2 patients had regional recurrence with one having pulmonary metastasis. We observed that positive or close margins (< 5mm after formalin fixation) predisposed to early recurrence. Erosion of pterygoid plates was a poor prognostic factor. Cervical lymph node metastasis occurred late in disease, but carried poor prognosis. Compartment resection of infra temporal fossa gave better outcome compared to other studies which reported outcome of treatment in upper alveolar cancers.

Multiaxial movements at the minke whale temporomandibular joint.

Mandibular mobility accompanying gape change in Northern and Antarctic minke whales was investigated by manipulating jaws of carcasses, recording jaw movements via digital instruments (inclinometers, accelerometers, and goniometers), and examining osteological and soft tissue movements via computed tomography (CT)-scans. We investigated longitudinal (α) rotation of the mandible and mediolateral displacement at the symphysis (Ω1 ) and temporomandibular joint (Ω2 ) as the mouth opened (Δ). Results indicated three phases of jaw opening. In the first phase, as gape increased from zero to 8°, there was slight (<1°) α and Ω rotation. As gape increased between 20 and 30°, the mandibles rotated slightly laterally (Mean 3°), the posterior condyles were slightly medially displaced (Mean 4°), and the anterior ends at the symphysis were laterally displaced (Mean 3°). In the third phase of jaw opening, from 30° to full (≥90°) gape, these motions reversed: mandibles rotated medially (Mean 29°), condyles were laterally displaced (Mean 14°), and symphyseal ends were medially displaced (Mean 1°). Movements were observed during jaw manipulation and analyzed with CT-images that confirmed quantitative inclinometer/accelerometer data, including the unstable intermediate (Phase 2) position. Together these shifting movements maintain a constant distance for adductor muscles stretched between the skull's temporal fossa and mandible's coronoid process. Mandibular rotation enlarges the buccal cavity's volume as much as 36%, likely to improve prey capture in rorqual lunge feeding; it may strengthen and stabilize jaw opening or closure, perhaps via a simple locking or unlocking mechanism. Rotated lips may brace baleen racks during filtration. Mandibular movements may serve a proprioceptive mechanosensory function, perhaps via the symphyseal organ, to guide prey engulfment and water expulsion for filtration.

The temporalis muscle and its relationship to the accessory attachments and the main pedicle—a cadaveric study

Lengthening temporalis myoplasty, described by Daniel Labbe in 1997, is a facial reanimation procedure for the treatment of facial nerve palsy. It involves the mobilization of temporalis muscle antero-inferiorly, and the insertion of its tendon at the nasolabial fold-oral commissure region. Knowledge of the temporalis muscle is crucial in performing this procedure; however, previous anatomical studies are limited. This study on cadavers, aimed to describe the anatomical location of the temporalis muscle insertion in relation to the adjacent structures, and its main pedicle to aid surgeons in performing this procedure. Twenty-four temporalis muscles were dissected in 12 fresh frozen cadavers. The anatomical location of the temporalis muscle insertion, accessory attachments, the emergence of the posterior deep temporal artery, and the distance of sliding movements from the coronoid process to the nasolabial fold were recorded. In addition to its origin from the temporalis fossa and its insertion at the coronoid process, the temporalis muscle was found to have multiple accessory attachments to adjacent structures. These findings explain the challenges in performing the sliding action without releasing the accessory attachments to the masseter and pterygoid muscles. The deep posterior temporal artery is located inferoposteriorly in relation to the muscle. Therefore, the muscle elevation maneuver performed without direct vision can be done with minimal risk to the muscle pedicle. The knowledge of temporalis muscle insertion, its accessory attachments, and its main pedicle will facilitate surgeons in performing the lengthening temporalis myoplasty more confidently.

A new peculiar species of the subterranean rodent Ctenomys (Rodentia, Ctenomyidae) from the Holocene of central Argentina

The subterranean rodent Ctenomys is the single living representative of the family Ctenomyidae, and the most diverse genus within Hystricomorpha. Its fossil record begins in the late Pliocene and shows an increase in diversity since the Pleistocene. Here we describe a new middle-sized Ctenomys species from a large cranial sample collected at the archaeological site Quebrada del Real 1 in the high plains of the Pampa de Achala (Córdoba, Argentina). For this goal, we analyzed the cranial and mandibular shape variation through a geometric morphometric approach, and performed a comparative morphological analysis in the context of the living Ctenomys. The new species is characterized by having a wide rostrum with a deep rostral fossa, strong temporal fossa in the frontal, upper incisors strongly procumbent and with grooved enamel, and mandible with low corpus, long procumbent diastema and descending masseteric crest. A phylogenetic analysis demonstrated its close affinity with Ctenomys osvaldoreigi, an extant species from a nearby area. The new species represents the first notice of an extinct Ctenomys species from the Holocene. Given its peculiar morphology, the extinction of this species would have resulted in significant loss of morphological diversity, thus constraining the current boundaries of variation of the genus. The last record of the new species occurs in a period characterized by marked extinction of small mammals in southern South America mainly due to anthropogenic causes.

Spheno-Temporal Langerhans Cell Histiocytosis: A Case Report

Langerhans cell histiocytosis (LCH) is a proliferation of Langerhans cells with inflammatory cells, characterized by the activation of histiocytic cells or their proliferation that affects structures of the human body, including the temporal bone which localization is rare in children. The objective of this study is to illustrate the clinical presentation, management and prognosis of this disease, and to compare our case with previously reported series. We report the case of a young 4-year-old patient with a history of otorrhea and recurrent otalgia, with left axillary non-blowing exophthalmia progressive since 5 months associated with indurated left temporal swelling and also an indurated swelling of posterior face of the left shoulder on pathological fracture. A cerebro-orbital MRI performed at home showed an extra-conical process with extension at the temporal fossa. The patient, then, underwent an open-air biopsy of the temporal mass and the pathological analysis returned to favor Langerhans cell histiocytosis. The diagnosis was made by immunohistochemical findings of the S-100 protein and/or the CD1 antigen. The child was treated by chemotherapy with a good outcome. Our results concord with literature. The prognosis is different and better in children with unifocal bone disease than those with a multifocal disease with a survival rate of 65% - 100%.

A Multicenter Randomized Controlled Pilot Trial Testing the Efficacy and Safety of Pterygopalatine Fossa Puncture Using One Acupuncture Needle for Moderate-to-Severe Persistent Allergic Rhinitis.

Objective To compare the efficacy and safety of pterygopalatine fossa puncture using one acupuncture needle inserted through the temporal fossa (intervention) and Chinese verum acupuncture (VA) in patients with moderate-to-severe persistent allergic rhinitis. Methods The patients were randomized to an intervention group receiving pterygopalatine fossa puncture with one acupuncture needle for 4 weeks (once or twice weekly, 4–8 sessions in total, with a second course performed if required) or to a control group receiving individualized VA for 4 weeks (twice weekly, eight sessions in total). Patients were followed up 4 weeks later. Results Ninety-six participants were assigned to intervention (n = 48) or VA (n = 48) or VA (P > 0.05 in all cases). Compared with the VA, the time to onset of effect in the intervention group was shorter and the duration of effectiveness was longer. The mean clinical waiting time was significantly shorter in the intervention group than in the control group (6.640 ± 3.035 min and 31.19 ± 10.216 min, respectively). The total number of sessions in the VA group was 384; 7 episodes of subcutaneous bleeding occurred but did not require treatment. The total number of sessions in the intervention group was 185. Two cases of subcutaneous bleeding (one of local hematoma during the intervention and the other one of bruising in the palpebra inferior on the day after intervention) resolved upon withdrawal from the study. Conclusions Pterygopalatine fossa puncture using one acupuncture needle resulted in a shorter time to onset of effect, a longer duration of effectiveness, and less clinical waiting time when compared with VA. Though the significant differences for TNSS and TNNSS were shown within intervention and VA groups, there were no differences between the two groups. Although the rate of subcutaneous bleeding was low, these adverse events may influence patient compliance. This trial is registered with ISRCTN21980724.

Reattachment of the Temporalis Muscle After Frontoorbital Advancement in Craniosynostosis Surgery.

Craniosynostosis surgery may result in temporal hollowing occasionally. Overexpansion of the normal side and undergrowth of the affected side exacerbate the problem in unilateral cases (like unicoronal synostosis). Temporalis muscle lies in the temporal fossa, and it is usually severed or detached from its origin in order to reach the lateral aspect of the fronto-orbital bar. Reattachment of the temporalis muscle is challenging especially when the orbital bar is moved forward. In this technical note, exposure of the lateral cranial vault with zigzag incision of the temporalis muscle in 35 nonsyndromic anterior plagiocephaly patients has been described in detail, and the ease of reattachment is demonstrated afterward.

A case report of temporal and infratemporal fossa abscess caused by periodontitis

A case report of temporal and infratemporal fossa abscess caused by periodontitis

Twin Block in Myogenous Orofacial Pain: Applied Anatomy, Technique Update, and Safety.

The twin block, introduced in 2014, has proven to be more advantageous for the management of myogenous orofacial pain than the masseteric nerve block, which was introduced in 2009. The twin block is an extraoral nerve block injection which passes through the temporal fossa to anesthetize both the masseteric and the deep temporal nerves as they exit the infratemporal fossa at the infratemporal crest. Similar to the masseteric nerve block, the twin block has demonstrated efficacy with expeditious and sustained relief of myogenous face pain originating from the masseter muscle. Furthermore, in a 6-month prospective treatment study, that has been accepted for publication, the twin block has been demonstrated as comparable to trigger point injections in the management of chronic myofascial pain of masseteric origin. The twin block's ability to mitigate myogenous pain from both the masseter and temporalis muscles and its ease of administration are the key advantages over the masseteric nerve block. Since its inception, we have refined the technique for administering the twin block and our clinical experience corroborates its safety and efficacy. This review describes the refined technique and its safety in the context of the region's applied anatomy.