Combined Technique of Temporal Muscle Augmentation for Muscle Reconstruction in Case of Small to Medium Anatomic Defects

Abstract

Inadequate temporal muscle (TM) reconstruction after surgery may hesitate in potentially severe functional and aesthetic sequelae, making it of paramount importance to carefully consider TM reconstruction even in case of small deformities. The authors describe the combined temporal muscle augmentation technique (CTMA), an innovative technique for TM augmentation for muscle reconstruction in case of small to medium substance loss. A cadaver study was conducted as preclinical validation of the technique for the assessment of CTMA coverage capability. CTMA consists in a combination of 2 techniques for muscle surface coverage (MSC) increase: the radial (RA) and the longitudinal augmentation (LA), which enables to harvest a radial (RF) and a longitudinal flap (LF), respectively. Each flap derives from a different muscle-bundle, spearing TM segmentation and functional performance, and are supplied by a specific neuro-vascular peduncle, which makes flaps functionally independent. A surgical case is reported to demonstrate the feasibility of the technique. Combined temporal muscle augmentation technique provides an overall coverage surface of 6.5 ± 0.6 cm2, which corresponds to a gap distance of 2.5 ± 0.2 cm, with RF providing a statistically significant larger surface of coverage compared to LF (×2.1; P = 0.0001). Combined temporal muscle augmentation technique is easy and fast to perform displaying a good reconstructive capability with complete preservation of temporal muscle anatomic compartmentalization and segmental vasculature. It might be considered as a safe and effective alternative in the reconstruction of small-to medium TM defects.

Temporal Flaps in Head and Neck Reconstructive Surgery: A Systematic Review of Surgical Techniques

“…The TM is anatomically divided into four bundles 14,17,18 : the anterolateral bundle (ALB), the anteromedial bundle (AMB), the mediolateral bundle (MLB), and the main portion (MP).…”

“…Each bundle is supplied by a specific vascular peduncle, making each of them as functionally independent. 14,17,18 The AMB, the upper part of the MP, and the MLB are supplied by branches arising from the anterior deep temporal artery (ADTA). The main part of the MLB is supplied by branches of the posterior deep temporal artery (PDTA), whereas the MP is supplied by branches arising from the transverse facial artery (TFA), which anyway plays only a marginal role.…”

“…The first step for TM reconstruction is AMB anchorage at the zygoma. 18 By using residual muscle bulk to reconstruct pterional fossa anatomy, a gap remained, where the posterior cut was made for muscle dissection during the surgical approach. The gap occurred between the MP and the MLB.…”

“…To overcome this limit, over the years, many techniques to reverse and split the muscle have been proposed. [16][17][18][19][20] Nevertheless, muscle splitting and reversing should be reserved for very selected cases due to the potential risk of impairment in flap's vascular supply, which may become particularly crucial in reconstruction reliability of radiated settings.…”

“…Segmentation has maximized flap shape versatility and reconstruction capabilities, thus optimizing cosmetic results. 14,17,18,21,22 Historically, each flap has had its own proponents and opponents, mostly based upon personal experience and surgeon's prevalent field of interest; nevertheless, a pointy review, systematizing techniques and comparatively analyzing different flaps, was still missing in the literature.…”