Temporalis Muscle Flap In Midfacial Region Defects

摘要

PURPOSE The study aims at defining the role and verifying the reliability of temporalis muscle flap in reconstruction of midfacial defects. We report our experience with the temporalis muscle flap in the reconstruction of midfacial defects. METHOD Five patients were included in the study and their defect reconstructed with the myofascial flap of the temporal muscle in just one operation. All the patients were operated by using Waber- Ferguson flap for primary tumor resection (hemimaxillectomy). For the reconstruction of the hemimaxillectomy defect, the flap was elevated with extended Al kayat- Bramley incision. RESULTS Temporalis muscle provided a large amount of well vascularized soft tissue, with minimal donor site morbidity. CONCLUSION The temporalis muscle flap is an excellent choice for maxillofacial reconstruction. 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. Introduction The maxillofacial form, oral competence and functions are the major aspects for the patients to meet the social needs after maxillectomies. With thorough knowledge of the anatomy of the various flaps and their applications, one can be more precise in the resection of tumors, leaving open the possibility of a primary closure of the defect and early rehabilitation. A variety of reconstruction techniques are being used to repair midfacial defects including skin grafts, local and regional flaps, as well as free-tissue transfer, but each of these techniques has its rewards and limitations. Reconstruction for the bony component of midfacial defects range from the use of soft-tissue alone to vascularized bone. The muscle provides a large amount of well vascularized soft tissue, with minimal donor site morbidity [1]. Temporalis muscle flap holds immense potential for the reconstruction of different maxillofacial defects [1]. Both its anatomical proximity to the midfacial region and to its easy transfer make this flap an excellent choice for reconstruction following the resection of midfacial tumors [2].Golovine (1898) was the first person to use the temporalis muscle flap to obliterate a dead space after orbital exenteration. Campbell (1948) used this flap to repair maxillary defects. After tumor resection in the maxilla, oropharynx and restoration of facial contour, the use of the temporalis muscle flap was described by Habel and Hensher [3].Temporalis muscle is a fan-shaped, thin peripherally and thick centrally. It originates from the side of the skull over the entire temporal fossa, from the inferior temporal line above to the infra-temporal crest below. The muscle is inserted to the coronoid process and the anterior border of the ramus of the mandible to the level of the retromolar area. Arterial supply runs on the deep surface of the muscle and arises from two vascular pedicles, the anterior and posterior deep temporal arteries which are the branch of internal maxillary artery and supply the anterior and posterior portions of the muscle respectively [4]. The nerve supply is via the anterior and posterior deep temporal nerves and occasionally from middle temporal nerve, which are branches of the anterior division of the mandibular nerve.In this study, we report on our experience with the temporalis muscle flap in the reconstruction of 5 cases of midfacial defects. The study aims at defining the role and verifying the reliability of temporalis muscle flap in reconstruction of midfacial defects. Material And Method All the patients were operated at Department of Oral and Maxillofacial Surgery Goa Dental College, Bambolim, Goa in one year span. A total of 05 patients were included in the study and their defect reconstructed with the myofascial flap of the temporal muscle in just one operation [Table 1]. Patients included had a large defect after hemimaxillectomy. The patients were evaluated preoperatively by clinical and r