The temporalis myofascial flap is classified as type iii axial pattern flap, based on two dominant arterial pedicle that is anterior and posterior deep temporal arteries it is because of this dependant vascular supply 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. Treatment of temporomandibular joint ankylosis with. Bilateral temporal myofascial flap for the reconstruction. In the absence of radiation, no skin grafting was necessary to cover the myofascial temporalis flap, as the entire flap remucosalized within 3 to 4 weeks of surgery. The biomimetic bone was placed under the temporalis myofascial flap when the temporal muscle had abundant blood supply. To evaluate the use of the temporalis myofascial flap in primary cranial base reconstruction following surgical tumor ablation and to explain technical issues, potential complications, and donor site consequences along with their management. Pdf the versatility of temporalis myofascial flap in maxillofacial. Temporalis muscle and fascia have been the most commonly used flap to provide a soft tissue interposition in gap arthroplasty, as well as in cases of tmj reconstruction. Reconstruction of the condyle unit was achieved using a costochondral graft securing with rigid or semirigid fixation technique. 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. Pdf superficial temporal myofascial flap application in. Department of plastic reconstructive and aesthetic surgery, dokuz eylul university, faculty of medicine, izmir, turkey. Temporalis myofascial flap tmf and immediate soft tissue reconstruction for maxillary, mandibular defects. Onepiece pedunculated frontotemporal orbitozygomatic.
Temporalis myofascial flap for primary cranial base. Treatment of temporomandibular joint ankylosis with temporalis superficial fascia flap article in military medicine 1702. 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. Temporalis muscle flap for the reconstruction oro facial defects case reportsoral sugery certified fixed orthodontic courses by indian dental academy 1. Comparison of clinical efficacy of temporalis myofascial. Functional outcomes and suitability of the temporalis myofascial flap for palatal and maxillary reconstruction after oncologic resection j. Use of the temporalis myofascial rotational flap has allowed expeditious treatment and rapid return of function, thereby maximizing the quality of life for the patient and minimizing the functional and cosmetic deficits. The versatility of temporalis myofascial flap in maxillofacial. After 4 years there was adequate mouth opening without recurrence. Coryza, lacrimation, salivation, changes in skin temperature, sweating, piloerection, proprioceptive disturbances, and erythema of the overlying skin are autonomic manifestations of myofascial pain. The ankylosed tmj was palpable and an incision was made directly onto the bone, exposing the ankylosed tmj. The study group comprised of 20 patients, both male and female patients between the age group of 6 years and 60 years underwent surgery under general anesthesia and temporalis myofascial flap was used for reconstruction of various types of maxillofacial defects including maxillectomy defects arising as a result of ablative surgery for tumors and treatment of aggressive.
Sc, cscs, pes what is self myofascial release and how does it work. Temporalis myofascial flap transfer into the oral cavity without zygomatic arch osteotomy david p tauro 1, madan mishra 2, gaurav singh 2 1 the taulins clinic, center for craniomaxillofacial, plastic and reconstructive surgery, bangalore, karnataka, india 2 department of oral and maxillofacial surgery, sardar patel postgraduate institute of dental and medical sciences, lucknow, uttar pradesh. Temporalis a broad, flat muscle on each side of the head, which is a key muscle in mastication. Self myofascial release technique by curb ivanic, m. Both radiated and nonradiated patients with the return of sensory function. Muscles that can cause pain in the teeth due to myofascial trigger points include. The authors divided the cases into two seriesbefore and after 1994because, after 1994, they started to perform free flap reconstructions, and indications for reconstruction with a temporalis muscle flap were changed results. The temporalis muscle is classified as a type iii 2 muscle receiving its main vascular supply from the anterior and deep temporal arteries, branches from the second portion of the internal maxillary artery. The versatility of temporalis myofascial flap in maxillo. The temporalis muscle and facial flap, as well as the dermal graft, are among the most popular ones. Temporalis myofascial flap transfer into the oral cavity.
This flap was secured with sutures in the temporalis fascia and in the parotid and cervical fascia. Patient showed satisfactory results and was under constant followup. Temporalis muscle flap and temporoparietal fascia flap. The role of the temporalis myofascial and pericranial flap in reconstruction of the orofacial region. The versatility of temporalis muscle flap in reconstruction of maxillofacial region anastasia dessy harsono, prasetyanugraheni kreshanti, siti handayani, kristaninta bangun jakarta, indonesia latar belakang. The anatomy and surgical technique of the temporalis myofascial flap has been well documented. The purpose of this article is to present our experience using the simple, reliable, and predictable temporalis myofascial flap tmf in rehabilitation and reconstructive surgery in cancer patients who are older and whose health is compromised in a way that precludes the use of microvascular free flaps.
Cenk demirdover 1, baris sahin 2, haluk vayvada 1, hasan yucel oztan 3. The series includes 9 patients 6 men and 3 women, ranging. The temporalis muscle flap is an excellent choice for maxillofacial reconstruction. Assessment of functional improvement with temporalis myofascial flap after condylectomy in elderly patients with anterior disc displacement without reduction and an erosive condylar surface by younghoon kang, jungsuk bok, bongwook park, munjeoung choi, jieun kim and juneho byun. The previous scar incision on the skin was cut to create a free skin flap, as was the underlying subcutaneous fat and galea aponeurotica. It is a strong, fibrous investment, covered, laterally, by the auricularis anterior and superior, by the galea aponeurotica, and by part of the orbicularis oculi. Applications of kite flap in reconstruction of cheek. Temporalis myofascial flap for maxillofacial reconstruction. In the years 19962010 we treated 10 patients with malignant neoplasms of maxillofacial region. The superficial temporal vessels and the auriculotemporal nerve cross it from below upward.
The temporalis muscle was exposed through a coronal inci. It is an axial flap based on the anterior and posterior. Both deep temporal arteries have a mean vessel diameter of 1 mm. The temporalis muscle flap comprises the temporalis muscle, with or without the overlying temporalis fascia. Otherwise, enough space was kept on the lower biomimetic bone edge for outside temporal muscle cranioplasty. Reddy2 and allen fred fielding3 1resident director, department of oral maxillofacial surgery temple university hospital, usa. 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. The temporal muscle, also known as the temporalis, is one of the muscles of mastication. Pdf temporalis myofascial flap transfer into the oral cavity without.
The study group comprised of 20 patients, both male and. Temporalis myofascial flap transfer into the oral cavity without. Barnes, pt, is an international lecturer, author and authority on myofascial release. The sensory disturbances that are produced are dysesthesias, hyperalgesia, and referred pain. Temporalis myofascial flap fared well in 16 out of 20 cases 80%. A total of 15 joints from 11 elderly patients 7178 years old were included.
Excision of the fibrous tissue and ankylotic bony mass was carried out using drill and saw. 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. In the series after 1994, flaps were most commonly used for reconstruction of. Assessment of functional improvement with temporalis. Temporalis muscle flap vula university of cape town. The graft was harvested from either the 5th or the 6th ribs where one graft was required, or from both. Reconstruction of palatomaxillary defects following cancer. In 1898, the temporoparietal fascia flap was described nearly simultaneously for reconstruction of the external ear after a horse bite and for reconstruction of the lower eyelid. Bilateral temporal myofascial flap for the reconstruction of frontal sinus defects. Journal of dentistry and oral biology impact factor. The vascular supply is the deep temporal artery, which originates from the internal maxillary artery fig. Reconstruction of the cranial base in surgery for jugular. The use of the temporalis myofascial flap in oral cancer. Efficacy of temporalis myofascial flap as an interpositional graft material in the management of tmj ankylosis.
Temporalis muscle an overview sciencedirect topics. A myofascial island flap for abdominal wall reconstruction was based on the lumbar component of the external abdominal oblique muscle and supplied by a major neurovascular pedicle consisting of branches of the cranial abdominal artery, cranial hypogastric nerve, and a satellite vein. Presents our experience in reconstruction of postsurgical defects with use of temporal muscle flap. The temporal muscle fascia lies deep to the tpf over the temporalis muscle. In conclusion, the described technique is anatomically.
The temporalis muscle lies deep to the temporoparietal fascia. 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. Patients were typically allowed to start oral intake of fluids on postoperative day 2. Investigation of operative skills and cranioplasty.
Despite these descriptions of its use in head and neck reconstruction, the flap remained an obscure and underused tool until an explosion of new descriptions of it. It was turned back to cover the temporalis muscle flap and the entire surgical field. Self myofascial release smfr is a great way to improve flexibility and mobility of tight muscles and restricted joints. Reconstruction of maxilla, soft palate and buccal mucosa. Combined intraoral and lateral temporal approach for. Temporalis myofascial flap in maxillary reconstruction. This study aimed to compare the shortterm clinical consequences between these 2 interpositional materials in patients with operated tmj ankylosis. Temporalis myofascial flap tmf and immediate soft tissue. Read reconstruction of palatomaxillary defects following cancer ablation with temporalis muscle flap in medically compromised patients. Superficial temporal myofascial flap application in temporomandibular joint arthroplasty in a cat. Pdf among plethora of options, the temporalis myofascial flap remains a workhorse for the maxillofacial reconstruction. Most commonly, the myofascial diagnosis will be of tmj temporomandibular joint dysfunction. Like the tpff, the tmf is a reliable, myofascial flap that was also described more than a century ago.
The anatomy of the flap and surgical technique are briefly presented. The myofascial temporalis fascia, cervical fascia, and sternocleidomastoid muscle flap was the third layer. The temporoparietal fascia tpf is an extension of the subcutaneous musculoaponeurotic system smas inferiorly and the galea aponeurotica superiorly. Temporalis muscle flap for the reconstruction oro facial. Abdominal wall reconstruction with a vascular external. He is considered to be a visionary and teacher of the highest caliber. Temporal muscle flap is especially easily predestinated for applying in reconstructive procedures of maxillafacial regions. Temporalis muscle flap for the reconstruction orofacial defects case reports indian dental academy leader in continuing dental education.
Its values are axial vascularization, location close to reconstruction site, easy harvest and good results with its use. If the inline pdf is not rendering correctly, you can download the pdf file here. Versatility of temporalis myofascial flap in maxillofacial. Twenty patients with tmj ankylosis were randomized in 2 age and sexmatched 10patient groups. It provides a thin sheet of vascularized fascia based on the superficial temporal artery and vein. We have developed a simple and easy modification of the orbitozygomatic approach using onepiece pedunculated craniotomy.
Radiated and nonradiated patients with the return of sensory function carl a. The tmj was lined with a temporalis muscle and fascia flap rotated over the arch into the joint. Kubikpreservation of the frontotemporal branch of the facial nerve using the interfascial temporalis flap for pterional craniotomy. Clinic of plastic reconstructive and aesthetic surgery, public hospital, mus, turkey. Temporal muscle flap in reconstruction of maxillofacial.
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