Temporal Flap Research Articles

Tratamento de Fratura do Seio Frontal seguido da Obliteração do Sistema de Drenagem: Relato de Caso

The higher prevalence of frontal sinus fractures occur in young male patients involved in car accidents. The fracture may affect the anterior wall and/or posterior, with or without involvement of the naso-frontal duct. The treatment of these fractures is extremely important because of the anatomical relationship of the sinus with the anterior cranial fossa and the roof of orbit. The surgery aims to restore function, aesthetics and prevent complications such as meningitis, encephalitis and pyocele. The best treatment to achieve these goals is with a proper diagnosis, focusing on physical examination associated with imaging. Surgical exploration and completion of the breast are needed when there is displacement of the anterior wall and the naso-frontal duct is injured. Completion of the airways requires meticulous curettage of the mucosa and permanent obliteration of the naso-frontal duct. This article presents a case of fracture of the anterior frontal sinus and orbital roof in a 16 years-old female patient involved in a car accident, for reconstruction of the defect, plates and screws were used and obliteration of the naso-frontal duct by filling the sinus with a temporalis muscle flap.

Dislocation of the intact mandibular condyle into the middle cranial fossa: a case report

Dislocation of the mandibular condyle into the middle cranial fossa is extremely rare. The authors present a case of superior dislocation of left condyle into the middle cranial fossa. The dislocated condyle was reduced successfully and then a flap of temporal muscle and a thin titanium network were used to repair the defect in the middle cranial fossa.

Comparison of Clinical Efficacy of Temporalis Myofascial Flap and Dermal Graft as Interpositional Material in Treatment of Temporomandibular Joint Ankylosis

Temporomandibular joint (TMJ) ankylosis is a very distressing structural condition. Interpositional arthroplasty has become the acceptable standard for the primary surgical management of TMJ ankylosis. Up to now, diverse interpositional materials have been proposed in this regard, with especial advantages and limitations. The temporalis muscle and facial flap, as well as the dermal graft, are among the most popular ones. This study aimed to compare the short-term clinical consequences between these 2 interpositional materials in patients with operated TMJ ankylosis. Twenty patients with TMJ ankylosis were randomized in 2 age- and sex-matched 10-patient groups and received either a temporalis muscle and facial flap or a dermal graft as the interpositional material. The maximal incisal opening (MIO) and the amount of lateral excursion (LE) were measured before and 3 months after surgery, and the mandibular deviation (MD) at the mouth opening 3 months after operation was compared between the 2 groups. Twenty patients were enrolled in the study. The presurgical MIO and LE were not significantly different between the 2 groups. Three months after the operation, evaluation of the patients did not reveal a significant difference considering the amount of the MIO, LE, or MD. The mentioned parameters were significantly improved 3 months after the operation in both groups. The interpositional arthroplasty in TMJ ankylosis patients using either a temporalis muscle and facial flap or a dermal graft would yield a comparable and almost satisfactory clinical outcome.

Lateral Brow Lift: A Surgical Proposal

In search of alternative techniques for lateral brow lifts in an attempt to offer a less traumatic procedure with lasting results, we developed a simple technique for a lateral brow lift (LBL) that involves suspending the lateral portion of the frontalis muscle. It replaces raising the temporal flap in a conventional face-lift. We present a description of the technique and review the histories of 71 patients who underwent this procedure in a private practice from 2002 to 2008. The technique may have been combined with a blepharoplasty or face-lift. The mean operative time was 20 min. Postoperative edema lasted 2 days. We obtained optimal results in 93% of the patients at postoperative month 6. There were complications in 10% of the cases, the most frequent of which was recidivism. No alopecia, paralysis, or vascular complications were observed. Our technique is safe and versatile and produces good results, which makes it an excellent choice in the surgical armamentarium of facial rejuvenation.

Intraoral Reconstruction Using Local and Regional Flaps

Choosing a pedicled flap to reconstruct an intraoral defect depends on the size and the anatomic position of the tissue defect. The goals are to restore form and function and minimize donor site morbidity. Regional pedicled flaps available for intraoral reconstruction are the buccal fat pad flap, facial artery musculomucosal flap, platysma, pectoralis major, temporalis muscle flap, and trapezius flaps. We give a concise illustration of anatomy, our harvesting technique, indications, and eventual pitfalls for each of the six flaps.

The use of pedicled temporal musculoperiosteal flap with or without free calvarial bone graft in maxillary reconstructions

Various techniques have been used to repair maxillary defects. The aim of this study was to evaluate the suitability of pedicled temporal musculoperiosteal flap (PTMF) and free calvarial bone graft for the reconstruction of maxillary defects. In this retrospective series, 34 patients operated on from 1995 to 2006 at Turku University Central Hospital because of defects of maxilla reconstructed using PTMF with or without free calvarial bone graft were evaluated. The diagnosis, the indication for surgery, the location and staging of the tumours, and the type of radiotherapy used were reviewed. The classification of the maxillary defects was performed according to the classification of Brown (Br J Oral Maxillofac Surg 40:183-190, 2002) and the success rates of the reconstructions were evaluated. Of the patients, 32 had been operated on due to a malignant tumour, one due to a benign tumour and one due to posttraumatic palatal defect. Preoperative radiotherapy (n = 14), preoperative chemoradiotherapy (n = 2) or postoperative radiotherapy (n = 11) had been used in the tumour group. As a reconstructive method, PTMF had been used with (n = 21) or without (n = 13) free calvarial bone graft. The use of free calvarial bone graft did not have a significant effect on flap survival. At 1-month follow-up, the flap survival in the 32 patients was 71.9%, whereas 28.1% of the patients suffered from partial flap loss, but there was no total flap loss. At 6-month follow-up, the flap survival in 26 patients was 76.9%, whereas 7.7% of the patients suffered from partial flap loss, and there were four (15.4%) total flap losses. If unilateral alveolar maxillectomy had been performed (Brown classification a), at 1-month follow-up, the flap survival was 82.6%, 17.4% of the patients suffered from partial flap loss, and there was no total flap loss. At 6-month follow-up, the flap survival was 89.5%, while 10.5% of the patients suffered from partial flap loss, and there was no total flap loss. The application of PTMF with or without free calvarial bone graft for reconstruction of limited palatal and maxillary defects appears to be feasible.

Transport Osteogenesis in the Maxillofacial Skeleton

To report our clinical experience using bifocal distraction osteogenesis (BDO) with internal devices to treat patients having bony defects of the maxillofacial skeleton following tumor ablation and to focus on outcomes of dental implant placement in patients having maxillomandibular segmental defects. Retrospective case series. Academic research. Patients were selected according to the following inclusion criteria: a bony defect in the maxillofacial skeleton, moderate soft-tissue defect, local or general conditions that preclude more aggressive surgery, and adequate patient compliance. Types of BDO included horizontal mandibular or maxillar alveolar, bilateral alveolar, vertical mandibular or maxillar, ramus and body, mandibular angle, symphysis, the 2-step procedure, temporalis muscle flap reconstruction, vascularized free-fibular flap reconstruction, radial forearm free-flap reconstruction, and pectoralis muscle flap reconstruction. The latency period was 10 days, after which distraction was initiated at a rate of 0.5 mm/d. The distraction period continued until the transport disk reached the distal stump. The consolidation period ranged from 8 to 48 weeks. Seven patients required additional bone grafting to complete union with the residual bone. Twenty-eight patients having bony defects of the maxillofacial skeleton underwent BDO. The mean (SD) bony defect length was 47.0 (20.1) mm. The mean (SD) distracted bone lengthening was 36.5 (20.0) mm, with a mean (SD) consolidation period of 16.4 (8.0) weeks. The bony defect involved the hemimandibular body in 12 patients, with greater involvement of the body and symphysis in 4 patients and of the bilateral mandibular body in 2 patients. Complications after BDO included the following: discomfort in 8 patients, complete intraoral exposure and infection in 3 patients, partial cutaneous exposure in 1 patient, premature consolidation in 1 patient, and temporomandibular joint ankylosis in 1 patient. Overall, BDO for reconstruction of bony defects was successful in 22 patients and failed in 6 patients. At the end of the follow-up period, 11 patients had undergone endosseous dental implant placement. Bifocal distraction osteogenesis potentially benefits patients with bony defects following tumor ablation at various locations in the maxillofacial skeleton. Sufficient bone is gained to allow dental implant placement, an important functional outcome.

The Versatility of Temporalis Muscle Flap in Reconstruction of Maxillofacial Region Defects

Introduction: The temporalis muscle flap is an axial pattern flap based on the anterior and posterior deep temporal arteries.It is most commonly utilized after maxillectomy. The temporalis flap splits into anterior and posterior halves, or the entiremuscle used as a flap.Objectives: The purpose of this study was to: 1. Evaluate the esthetic and functional outcome by using temporalis muscleflap for reconstruction of intraoral defect. 2. Assess the effectiveness of temporalis muscle flap in intraoral defects.Study Design: It was a Descriptive studySetting: The study carried out at department of Oral and Maxillofacial Surgery King Edward Medical University / MayoHospital Lahore.Subjects and MethodsDuration: The study was completed in six months from 1st June 2005 to 30th Nov 2005.Sample size: 30 patients who presented with intraoral defect were included in this study.Sample Technique: Nonprobability Sampling (Purposive).Results: Success rate was ninety percent in this study. Failure of flaps encountered in 10% cases especially in older andimmunocompromised patients.Conclusions: Temporalis muscle flap is a good choice for most of the intraoral defects especially those in palatal and buccalregion.Key Words: Temporalis muscle flap, Palatal reconstruction, oral cavity, Mucosalisations.

Temporalis Muscle Flap In Midfacial Region Defects

Temporalis Muscle Flap In Midfacial Region Defects

A New Design for Superficial Temporal Fascial Flap for Reconstruction of the Eyebrow, Upper and Lower Eyelids, and Lacrimal System in One-Stage Procedure

Reconstruction of the eyebrows, eyelids, and destroyed lacrimal drainage system is a challenging procedure for plastic and reconstructive surgeons. In the case presented, a superficial temporal fascial flap was designed for reconstruction of the eyebrow, upper and lower eyelids, and lacrimal drainage system in a one-stage procedure in facial burn patient. To the authors' knowledge, this is the first combined reconstruction of the eyebrow, upper and lower eyelids, and lacrimal drainage system in one surgical procedure with pedicled superficial temporal fascial flap including skin island and buccal mucosal graft. During the 1-year follow-up period, no complication was encountered and patient healed uneventfully.

Upper eyelid reconstruction: a short report of an eyelid defect following a thermal burn

While the principles of eyelid reconstruction are well-established, achieving good functional and aesthetic reconstruction remains challenging.This communication presents a technique that we used on a young patient with an eyelid defect following a thermal burn. The patient was operated on to reconstruct the entire upper eyelid using, as a posterior lamella, a mucochondrial autologous graft taken from the ala of the nose as a tarsus and conjunctiva substitutes that were sutured to the Elevator palpebrae superioris aponeurosis and muscle. On the other hand, to reconstruct the anterior lamella, which consists of skin and muscle, the surgeons used a myocutaneous temporal flap taken from the region immediately lateral to the external canthus of the palpebral region, and which, after being isolated following a drawing of the upper eyelid to be reconstructed, was rotated and then sutured to the posterior lamella using the orbicularis oculi muscle as a pedicle.

Temporomandibular Joint Reconstruction With a 2-Part Chrome-Cobalt Prosthesis, Chondro-Osseous Graft, and Silastic

Seventy-six patients including 27 females and 49 males, with ages ranging between 4 and 35 years (mean, 19.5 y), all experienced loss of weight, stiff temporomandibular joints and inability to chew food, and facial deformities. These patients were treated in the Maxillofacial Unit, Surgical Specialties Hospital, Medical City, Baghdad, Iraq, using 4 different techniques according to the requirement of each case and the facilities available. These patients were divided into 4 groups: the first group consists of 16 children (21.06%) treated with a chondro-osseous graft; the second group, 10 children (13.16%) treated with a 2-part chrome-cobalt prosthesis; the third group, 32 children (42.11%) treated with a Sialastic rubber silicone implant (Koken Co, Tokyo, Japan); and the fourth group, 18 children (23.69%) treated with interposition arthroplasty with a temporalis muscle flap. The follow-up period of the cases ranged between 3 and 15 years. Experimental studies were done on using rabbits to assess the viability of the chondro-osseous graft and on monkeys to demonstrate the biological acceptability of the 2-part chrome-cobalt prosthesis. The aim of this clinical and experimental study was to show our experience in managing difficult tasks that craniofacial or maxillofacial surgeons may face and to share these experiences with other colleagues all over the world.

Treatment of temporomandibular joint ankylosis: gap and interpositional arthroplasty with temporalis muscle flap

The purpose of this study was to examine the effectiveness of gap and interpositional arthroplasty with temporalis muscle flap in the treatment of the temporomandibular joint (TMJ) ankylosis. This retrospective study was evaluated on 34 patients who were treated from February 2003 to July 2007. Diagnosis of TMJ ankylosis was based upon the clinical examination and plain radiography and CT scan. Eight patients (23.5%) had bilateral TMJ ankylosis, and four patients had reankylosis (that had been operated in another center). Trauma was the most etiological factor (88.2%) and osteochondroma of the condyle in one patient caused ankylosis. Means of maximum mouth opening before and after operation were 5.00 (SD) 3.45 mm and 32.85 (SD) 5.51 mm, respectively. Reankylosis in two patients (5.9%) and facial nerve dysfunction in 12 surgery sides (28.5%) were noted. The findings of this study suggest that the gap arthroplasty with temporalis muscle flap as interpositional graft is an effective method in the treatment of TMJ ankylosis. The osteoarthrectomy of the callus to create at least 10 mm gap and enough bulk of temporalis muscle flap as interpositional graft followed by at least a 6-month physiotherapy which play an important role in prevention of reankylosis.

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.

Reconstruction of Middle Third Defects of the Face With the Temporal Flap

The temporal flap is of great interest in head and neck reconstruction when a skin graft or a local flap cannot be used. It has shown important results on the facial reanimation and in oncological surgery. We describe our experience with the pedicled flap in reconstruction of the middle third face defects in 8 oncologic patients. This flap allows the covering of bone and noble structures such as the periorbital, auricular, frontal, or parotid gland areas. Few major or minor complications were seen and good aesthetic results were achieved. It also can be done with or without adjuvant radiotherapy. The patient prognosis however, depends on the stage of the tumor.

High-resolution optical coherence tomography visualization of LASIK flap displacement

Uneventful myopic laser in situ keratomileusis (LASIK) was performed in both eyes of a 33-year-old woman. Two weeks after LASIK, examination of the left eye revealed flap striae radiating inferonasally from the superior hinge. The flap was relifted and repositioned to remove the irregular astigmatism and reduce the striae. Before the flap was relifted, Fourier-domain optical coherence tomography (FD-OCT) showed the gap at the temporal flap, which had not been detected by biomicroscopy. After the flap was relifted, FD-OCT documented that the gap was closed. High-resolution FD-OCT was helpful in the visualization and management of flap displacement.

Endoscopic Harvest of a Temporalis Flap for a Maxillary Reconstruction

The use of a temporalis muscle flap for reconstruction of the maxilla is a common technique at the moment. One of the disadvantages of applying this technique is the anesthetic scar generated in the temporalis fossa and the depression of this area. We present a new method for endoscopically harvesting the muscle flap, through minimal incisions situated in the temporalis fossa and preauricular region. This endoscopic technique has not been described in the literature for a hemimaxillary reconstruction. We present the first case of a maxillary reconstruction with an endoscopically assisted temporalis muscle flap with excellent results.

Temporalis muscle flap for reconstruction of skull base defects

The temporalis muscle flap (TMF) is a valuable reconstructive technique utilized in a variety of challenging defects. However, its use for repair of skull base defects is less commonly reported. A retrospective chart review was conducted for 35 patients who underwent reconstruction of skull base defects between March 1999 and July 2006 at a tertiary referral hospital. Patients with skull base defects after trauma or extirpative surgery underwent reconstruction with a TMF. The measured outcomes were as follows: defect size/location, need for additional flaps, bone necrosis, hardware exposure, dehiscence, cerebrospinal fluid (CSF) leak, and meningitis. Forty-two patients underwent reconstruction with a TMF, and 35/42 patient records were available for review. No flap failures, 1 transient CSF leak, 3 hardware exposures distant from the temporalis recipient site, and 3 hydroxyapatite cement infections or foreign body reaction were observed. The TMF represents a versatile reconstructive technique employed with minimal morbidity and a low complication rate to repair defects of the skull base.

Comparison of Gap Arthroplasty With and Without a Temporalis Muscle Flap for the Treatment of Ankylosis

The purpose of this study was to compare gap arthroplasty with and without a temporalis muscle flap for the treatment of ankylosis. Sixteen patients with temporomandibular joint ankylosis from 2001 to 2006 were included in the study, of which 7 were female and 9 were male. Fourteen patients had unilateral ankylosis and 2 patients had bilateral ankylosis. Sixteen patients were divided into 2 groups with 8 patients in each group. In group I patients, gap arthroplasty was performed with a mean follow-up of 20.3 months and in group II patients, interpositional arthroplasty with temporalis myofacial flap was performed with a mean follow-up of 23.1 months. All patients were assessed for mouth opening, diet consistency, and weight postoperatively. All patients were subjected to postoperative mouth opening exercises from the second postoperative day. There is no significant difference in postoperative mouth opening, diet consistency, and weight of the patients in both groups. Reankylosis occurred in 1 patient in both groups. We conclude that there is no significant difference in maximal interincisal opening, diet scores, and weight of the patients in both groups. The overall outcome of the treatment depends on patient cooperation, active physiotherapy, and regular follow-up.

Temporomandibular Joint Ankylosis (A prospective clinical study)

Background and objective: To study the correlation between etiology, sex, side and time of TMJA, to evaluate and compare two different surgical techniques and their postoperative complications. Methods: Twenty-one patients (15 female , 6 male) were treated in Rizgary Teaching Hospital in Hawler during the period May 2007-October 2008. The patients were referred from Hawler and Duhok governorates, and operated on by two surgeons each adopted one surgical technique, either gap arthroplasty with temporalis muscle flap (technique A) or horizontal ramus osteoctomy with masseter muscle flap (technique B). Results: We found 95.65% of patients had TMJA before the age of ten years and 96% was due to trauma (57% was bilateral TMJA and 43% unilateral), technique (B) was easier and of shorter duration than technique (A) which was more functional. The most common postoperative complication was neural deficit (33.33%). Anterior open-bite occurred in 36.3% of patients with bilateral ankylosis. Conclusion: The earlier the onset of ankylosis, the more the extent of deformity and the more complicated surgical technique was required. Both techniques were effective with good immediate out come.