Vishal sharma 1, krishna prasad koirala 2, brijesh sathian 3. Reconstruction of orbital suprastructure maxillectomy. The proximity of the oral cavity, palate, oropharynx, the middle third of the face in addition to the vascular pedicle make the temporalis myofascial flap valuable for reconstruction. Subsequently, this flap was used in reconstructions involving several head and neck regions including the mastoid, 3 maxilla, 4.
Temporalis myofascial flap for primary cranial base. Case summarya 2yearold, intact female domestic longhair cat was referred for surgical treatment after diagnosis of closed jaw locking secondarily to right temporomandibular joint ankylosis and le. Efforts have been made to classify these midfacial defects and provide. The temporalis muscle is found deep to the temporalis muscle fascia. Previous articles submental myocutaneous island flap for repairing oral and oropharynx defects after cancer ablation. There are many reconstructive surgeries to use for these cases, including temporalis myofascial flap 1 and alloplastic total joint replacement 2, 3. Previous articles next articles reconstruction of throughandthrough cheek defects following extensive surgical dissection of malignant tumor using faciocervicopectoral flap and temporalis myofascial flap. Thieme ejournals asian journal of oncology full text. It is a very reliable, versatile flap that is usually available in the operative field with relatively low donor site aesthetic and functional morbidity. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. It has also been used as a myofascial flap intraorally. Management of oral submucous fibrosis by different. Combined intraoral and lateral temporal approach for.
A total of 15 joints from 11 elderly patients 7178 years old were included. Cosmetic reconstruction of frontotemporal depression using. The temporalis flap is also a pedicled, but predominantly myogenous, flap that receives its blood supply from the deep temporal vessels and is usually used in skull base reconstruction. Sankara narayanan, at the stem cell therapy unit of kmc hospital, trichy, in tami nadu has reportedly developed a nonsurgical form of treatment using autologous bone marrow stem cellsstem cell therapy to treat osmf and to change the malignant potential.
Clinical applications the temporalis muscle flap may be used for reconstruction of defects of the oral cavity floor of mouth, tongue, buccal, retromolar trigone, palate, oropharynx, nasopharynx, orbit, maxilla and facial soft tissues. The anatomy of the flap and surgical technique are briefly presented. The versatility of temporalis myofascial flap in maxillo. The pedicled temporalis muscle flap is a reliable and highly versatile flap that receives blood supply from the anterior and posterior deep temporal arteries, which. The galeal frontalis myofascial flap was folded down into the anterior cranial base. Past studies have shown the temporalis myofascial flap to be safe as well as effective. The enhancing, thin, curvilinear pericranial flap bridges an osseous defect of the anterior skull base. We have proposed herein a simpler technique of temporalis myofascial flap transposition into the oral cavity without zygomatic arch osteotomy. Elongated miofascial temporal flap in comparison with standard. Above the temporalis muscle, the pericranium and skull lie deep to the tpf. These lesions usually cause cerebrospinal fluid csf leakage, intracranial infection, and bone resorption. Efficacy of interpositional arthroplasty with temporalis. The temporalis myofascial flap is a versatile option for reconstruction of moderate to large sized maxillofacial defects, the muscle can provide abundant viable and vascular tissue, with minimal to no functional morbidity or esthetic deformity at the donor site.
The tmj was lined with a temporalis muscle and fascia flap rotated over the. Temporalis myofascial flap for maxillofacial reconstruction. Objectivesto report our experience with temporalis myofascial flaps tmf, describe the healing process of uncovered flaps in the mouth, and the histology of. Recent advances temporalis myofascial flap for reconstruction in osmf. They concluded that cgf was a promising material for repairing jaw defects by promoting new bone formation. Using this surgical technique, 12 patients and tmjs yielded. In conclusion, the described technique is anatomically sound, easy to. Extended subgaleal fascia pericranial temporalis flap for skull. It is hypothesized that both speech and swallowing function are preserved following tmf. Temporalis myofascial flap for maxillofacial and oral defect article pdf available in otolaryngology head and neck surgery 1452 suppl. Applications of kite flap in reconstruction of cheek. A narrow myofascial cuff should be left superiorly along the superior temporal line for later reapproximation fig. The arterial supply of the temporalis muscle the arterial supply of the temporalis muscle elazab, eman. Use of temporomyofascial flap for reconstruction of maxillary defect.
Experience gained with 26 temporalis flaps in reconstruction of tissue defects in the periorbital region, skull base, maxilla, and oral cavity is presented. The temporalis muscle flap is a reliable, nonbulky, myofascial flap that has been used for closure of a variety of defects as well as reconstruction both of medium and large areas of the maxillofacial region. This prospective study was to compare the results of pediatric modified radical mastoidectomy. Pdf intraoral defect coverage with muscle flaps bodo. The temporalis myofascial flap was found to be an excellent reconstructive alternative for a wide variety of skull base defects following tumor ablation. The technique of flap elevation and transposition is the same as. The temporalis muscle flap is an excellent choice for maxillofacial reconstruction. Longterm functional and esthetic results were shown to be stable. Choice of myocutaneous or myofascial flap was dictated by defect volume considerations and surgeon preference. The anatomy and surgical technique of the temporalis. To date, the temporalis myofascial flap has been used only to a limited extent for reconstruction in the maxillofacial region.
The versatility of temporalis myofascial flap in maxillofacial. Criteria used to evaluate the results of this technique included flap necrosis. The artery is a branch of the external carotid system. The merits of this flap includes its slim size, flexibility, and the fascia in contract with the oral cavity, which. Like the tpff, the tmf is a reliable, myofascial flap that was also described more than a century ago. The flap was then turned down over the arch and into the fossa. The material of the present study consisted of 44 specimens, four obtained. The temporalis muscle flap was preferred for reconstruction in this study.
Temporalis myofascial flap transfer into the oral cavity without. We aim to reaffirm the temporalis myofascial flap as a viable alternative to free flaps for palate reconstruction. Read the pedicled temporoparietal fascial flap for complex midfacial reconstruction, operative techniques in otolaryngologyhead and neck surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. To study the use of the temporalis myofascial flap in the reconstruction. The temporalis muscle flap in reconstruction of intraoral defects. Considerations for freeflap reconstruction of the hard. This type of facial reconstruction attracts controversy, not only because of the many reconstructive options, but also because dental and facial prostheses can be very successful in selected cases. Temporalis myofascial flap for primary cranial base reconstruction after tumor resection article pdf available in skull base surgery 184. On imaging studies, the tendon and fractured coronoid process are clues to the presence of a temporalis myofascial flap. Regional flaps used to reconstruct the palate include the temporalis myofascial flap, 16 a nasal septal flap, 17 an infrahyoid myocutaneous flap, 18 and a pectoralis major. The suggested aetiological factor is the practice of certain customshabits of the inhabitants of south east asia. Coloured areas illustrate the different ostectomies performed. The temporal muscle, also known as the temporalis, is one of the muscles of mastication. They noted satisfactory compensation of temporalis muscle atrophy and no implantrelated complications.
Gcts is a rare benign lesion that not only frequently occurs in the fingers, but also along the tendon sheaths of the foot and ankle. Temporalis muscle flap vula university of cape town. The supraclavicular artery flap for lateral skull and. The anterolateral thigh alt flap is considered to be a workhorse flap for reconstruction of maxillary defects. Myocutaneous free flaps were used in most hemipalate defects. Most patients requiring midface reconstruction have had ablative surgery for malignant disease, and most require postoperative radiotherapy. Loss of the maxilla and midfacial structures after tumour removal has substantial functional and aesthetic consequences. Free flap reconstruction of palate defects is also a popular method used by contemporary surgeons. The purpose of this study was to investigate the functional effects of temporalis myofascial flap after condylectomy, with or without disc removal, in elderly patients with anterior disc displacement add without reduction and an erosive condylar surface of the temporomandibular joint tmj.
Ameloblastoma, maxillectomy, temporalis myofascial flap. Temporalis myofascial flap in maxillofacial reconstruction. Through the lateral edge of the craniotomy, the vascularized splitthickness calvarial bone flap was brought in the anterior cranial fossa and then placed on the galeal frontalis myofascial flap over the bony defect. An extended subgaleal fascia pericranial flap based on the temporalis muscle is described. Submental myocutaneous island flap for repairing oral and. Pdf temporalis myofascial flap transfer into the oral cavity without. Temporalis myofascial flap for primary cranial base reconstruction. The blood supply of the tpf flap is from the superficial temporal artery and vein. A group of threeelongated myofascial flap, which includes lifting the muscle. Temporal hollowing augmentation with titanium mesh after autologous cranioplasty in temporal muscle resected case. The present study was done to evaluate the efficacy of interpositional arthroplasty with temporalis muscle and fascia myofascia flap in preventing the reankylosis, to evaluate the growth of mandible, and to assess alkayat and bramleys incision for its versatility in allowing muscle transfer and excellent exposure of the joint. Among the flaps proposed, the temporalis muscle flap tmf is a reliable and safe myofascial flap that has been used for the reconstruction of various maxillofacial defects cordeiro and santamaria, 2000, hanasono et al.
All patients underwent temporalis myofascial flap reconstruction after condylectomy, with or without disc removal. Ankylosis of temporomandibular joint musculoskeletal. Determination of whether to use a bonecontaining flap was largely based on the quantity and quality of the patients residual dentition andor denturebearing alveolar arch. Chances of developing cavity granulations or infection are also reduced. Additionally, it has better vascularization than dermal and skin grafts and results in a better cosmetic appearance. Drill holes into the bone of the lateral lip of the glenoid fossa were made posteriorly and anteriorly prior. Assessment of functional improvement with temporalis myofascial. Pdf temporalis myofascial flap for primary cranial base.
The temporalis muscle flap for palate reconstruction. Reconstruction of the anterior cranial base with the. Pdf among plethora of options, the temporalis myofascial flap remains a. Temporalis myofascial flap tmf and immediate soft tissue. Patients and method this series of 9 patients 6 men and 3 women, were treated at the department.
Figure 2 schematic drawing of the temporalis myofascial flap transposition. As the disease progresses, the oral mucosa becomes stiff due to the formation of fibrotic bands in the cheek, ultimately leading to. Pdf temporalis myofascial flap for maxillofacial and. The temporalis muscle flap is generally thought to be a straightforward, reliable, regional flap with axial blood supply, and adequate bulk and flexibility for many craniofacial defects. Obliteration of the mastoid cavity leaves a smaller cavity with quicker as well as better healing. The anatomy and surgical technique of the temporalis myofascial flap has been well documented. The temporalis myofascial flap tmff is a locally available, safe and reliable flap which can be used for the reconstruction of various orbital and supramaxillary facial defects. However, the use of alt flap to repair extensive defects is associated with significant donor site morbidity, but mismatch of the texture and color and in extensive cases. Temporal augmentation with methyl methacrylate aesthetic. It is a broad, fanshaped muscle on each side of the head that fills the temporal fossa, superior to the zygomatic arch so it covers much of the temporal bone. A case report taeyong park, md, jihee kim, md, won seok chang, md, jin woo chang, md, yong gou park, md and hyun ho jung, md division of stereotactic and functional neurosurgery, brain research institute, department of neurosurgery, yonsei university college of.
In more recent years, a pedicled temporalis myofascial or temporalis fascia flap has been advocated in. The variable loss of soft tissue, bone, or both, leading to collapse of the lip, cheek, periorbital soft tissues, and palatal competence present a challenging dilemma for reconstructive surgeons. In their article, they conducted a prospective study on the efficacy of concentrated growth factor cgf in jaw bone defects. Mr imaging of the muscular component of myocutaneous flaps.
Pdf the versatility of temporalis myofascial flap in maxillofacial. Functional outcomes and suitability of the temporalis. The vascular supply is the deep temporal artery, which originates from the internal maxillary artery fig. Open cavity versus periostealtemporofascial flap obliteration. Temporalis flap complications table 3 lists postoperative complications related to the use of the temporalis myofascial. It is easy to perform and adequate in terms of length, width and volume. We read with great interest the recent article by fang et al 1 in journal of oral and maxillofacial surgery. He and yang reduced the relapse by using a temporalis myofascial flap or a free fat graft from the belly to fill the lateral osteotomic gap 2, 4. This flap has a good vascularization and it is close to the defect region. A retrospective study of temporalis muscle and fascia flap in. The use of temporal polyethylene implant after temporalis myofascial flap transposition. Temporalis muscle flap and temporoparietal fascia flap.
If the inline pdf is not rendering correctly, you can download the pdf file here. Our study describes the mr imaging features of the muscular component of myocutaneous flaps. The temporal muscle fascia lies deep to the tpf over the temporalis muscle. Oral submucous fibrosis osmf is an insidious chronic progressive disease of the oral cavity which is considered as a precancerous condition.
Superficial temporal myofascial flap application in. Download as ppt, pdf, txt or read online from scribd. The temporalis flap is one of the first reported muscle flaps described by lentz 1 in 1895, who used it after resection of the condylar neck for temporomandibular joint ankylosis. The temporalis myofascial flap tmf is a method of palatal reconstruction that offers a single.
Ebrahimi, comparison of clinical efficacy of temporalis myofascial flap and dermal graft as interpositional material in treatment of temporomandibular joint ankylosis. This study describes a technique for temporal myofascial segmentation to harvest a multilayered vascularized flap for mf reconstruction, which might preserve temporal muscle tm function and its blood supply. Protection of the lateral semicircular canal by soft tissue obliteration also prevents vertigo episodes on exposure to cold air. Temporalis myofascial flap in maxillary reconstruction.
In 1898, golovine 2 used the flap to reconstruct an orbital exenteration defect. A large, bulky muscle and subcutaneous fat are characteristic of a free flap with microvascular anastomosis. Combined intraoral and lateral temporal approach for palatal malignancies with temporalis muscle reconstruction. The technique to harvest a combined segmented temporal myofascial flap cstmf is described. Sellarifranceschini s, tschabitscher m, muscatello l. Evaluation of the condyle remodeling after lateral. Assessment of functional improvement with temporalis.
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