Reverse Temporalis Muscle Flap for the Reconstruction of Orbital Exenteration Defects

Abstract

Orbital exenteration is a surgical procedure that results in devastating functional and aesthetic losses. Many reconstructive techniques, ranging from spontaneous epithelialization to free flaps, have been described for orbital exenteration defects. The temporalis muscle flap is one of the most frequently used flaps to obliterate the orbital cavity, but only a small portion of the muscle can be used for this purpose because most of the muscle is used as the pedicle. The reverse temporalis muscle flap based on the superficial temporal vessels is a versatile flap by which the entire temporalis muscle can be elevated and carried to defects beyond the midline. The authors have used this flap for orbital reconstruction after exenteration in 6 patients with successful results. This flap enables placement of highly vascularized tissue that provides the reconstructive goals of primary healing, obliterates dead space with separation of the orbit from the nasal cavity or sinuses, provides the potential for early postoperative radiotherapy, and offers possible flaps that can be used in combination for complex, wide defects.

Review of orbital exenterations in Korle-Bu Teaching Hospital

“…[7][8][9][10] These techniques offer rapid healing and provide for the application of prosthesis. However they are not suitable in cases where tumour recurrence is likely.…”

“…But even these techniques are usually reserved for more benign and less aggressive tumours. 10,[12][13][14] A majority of patients (76%) in this study were neglected invasive squamous cell carcinomas (SCC) arising from the conjunctiva invading the orbit. Although conjunctival SCC is known to be relatively nonaggressive tumour, especially in Caucasians, a few studies from tropical and subtropical regions suggest that in these areas, this type of cancer behaves in an aggressive fashion and tends to affect younger individuals.…”

“…3,6 Several techniques for cosmetic repair have also been described. [7][8][9][10] However in some cases the orbit is left to granulate. 3 This study reports our experience of OE in a Teaching Hospital in Accra, Ghana.…”

Reconstruction after extended orbital exenteration using a fronto-lateral flap

“…The ideal reconstruction also offers a satisfactory aesthetic result 11 . Cutaneous covering is important in patients requiring postoperative radiotherapy.…”

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

“…In 2002, Menderes A in Turkey did a study on the use of Temporalis muscle flap for the reconstruction of the orbital exenteration defects and found that this flap enables placement of highly vascularized tissue that provides the reconstructive goals of primary healing obliterating dead space with separation of the orbit from nasal cavity or sinuses 5 . In 2003, Balaji SM did study in India on Temporalis anchorage in crainiomandibular ankylosis and found that Temporalis muscle flap is an ideal interpositional material due to its close proximity to the site and good vascular supply 6 .…”