Temporalis Myofascial Flap for Primary Cranial Base Reconstruction after Tumor Resection

Abstract

Objective: 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. Design: Retrospective case series. Setting: Tertiary referral center. Participants: Forty-one consecutive patients receiving primary temporalis myofascial flap reconstructions following cranial base tumor resections in a 4-year period. Main Outcome Measures: Flap survival, postoperative complications, and donor site morbidity. Results: Patients included 37 males and 4 females ranging in age from 10 to 65 years. Two patients received preoperative and 18 postoperative radiation therapy. Patient follow-up ranged from 4 to 39 months. The whole temporalis muscle was used in 26 patients (63.4%) and only part of a coronally split muscle was used in 15 patients (36.6%). Nine patients had primary donor site reconstruction using a Medpor 1 (Porex Surgical, Inc., Newnan, GA) temporal fossa implant; these had excellent aesthetic results. There were no cases of complete flap loss. Partial flap dehiscence was seen in six patients (14.6%); only two required surgical débridement. None of the patients developed cerebrospinal leaks or meningitis. One patient was left with complete paralysis of the temporal branch of the facial nerve. Three patients (all had received postoperative irradiation) developed permanent trismus. Conclusions: The temporalis myofascial flap was found to be an excellent reconstructive alternative for a wide variety of skull base defects following tumor ablation. It is a very reliable, versatile flap that is usually available in the operative field with relatively low donor site aesthetic and functional morbidity.

Advanced Cranial Reconstruction Using Intracranial Free Flaps and Cranial Bone Grafts

“…Successful obliteration of the dead space and reconstruction of cranial base defects has been reported by Neligan et al using free tissue transfer. 24,25 Our results compare favorably with the literature, using free tissue transfer to obliterate extensive dead space before definitive cranioplasty. Our single free flap failure was caused by venous congestion, presumably attributable to the large zone of injury.…”

Temporalis muscle flap for immediate reconstruction of maxillary defects: Review of 39 cases

“…Eldaly et al advocated that during the initial stages of healing of the TMF, granulation tissue forms over it, which leads to an increase in bulk of the flap during the first 2-3 months. 6 The excessive granulation tissue formation and the subsequent fibrosis can cause temporary difficulties in chewing, mouth opening, and swallowing. 6 The main goal of any reconstruction is to maximise function and form.…”

“…6 The excessive granulation tissue formation and the subsequent fibrosis can cause temporary difficulties in chewing, mouth opening, and swallowing. 6 The main goal of any reconstruction is to maximise function and form. The main disadvantage of this flap is lack of sufficient bone for occlusal rehabilitation.…”

Orbital Skull Base Reconstruction with Temporalis Muscle: The Sphenoid Keyhole Technique

“…2 Since its innovation, the temporalis flap has demonstrated excellent versatility for reconstructive ability for several head and neck areas. [3][4][5] The temporalis muscle is fan-shaped and is located lateral to the temporal fossa. It travels deep to the zygomatic arch where it inserts onto the coronoid process and ascending ramus of the mandible.…”

“…5 The temporalis muscle is commonly used for skull base reconstruction. 3,5,6 It has multiple advantages over other pedicle flaps such as the trapezius, deltopectoral, and pectoralis major flaps due to its minimal bulk, short distance to defect, small arc of rotation, and minimal morbidity to the donor site. However, challenges surrounding muscle length, arc of rotation around the lateral orbital wall, and tension can preclude the use of this flap, and sometimes subject the patient to more morbid options such as free tissue transfer.…”