Split temporalis muscle flap anatomy, vascularization and clinical applications
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ORIGINAL ARTICLE
Split temporalis muscle flap anatomy, vascularization and clinical applications A. Veyssiere • J. Rod • N. Leprovost A. Caillot • D. Labbe´ • A. Gerdom • B. Lengele´ • H. Benateau
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Received: 11 October 2012 / Accepted: 23 January 2013 Ó Springer-Verlag France 2013
Abstract Introduction For more than a century, the temporalis muscle has been used for facial reconstructions. More recently, a split temporalis muscle flap elevated on the superficial temporal pedicle has been described, for which the resulting gain of length makes crossing of the midline possible, as well as reconstruction of substance losses exceeding the midline. Materials and methods Fourteen fresh cadaveric dissections were performed to study the different techniques for splitting the temporalis muscle. Dissections with catheterization and injection of radio-opaque contrasting agent in the external carotid artery were then performed to specify the vascularization of the flap split on the superficial temporal pedicle. Results The duplication of the superficial temporal pedicle grants greater length compared to that of the deep pedicles, 57 mm versus 40 (p = 0.036). The middle temporal artery is capable of ensuring the vascularization, and therefore the viability, of the split flap. From these results, we spoke about the limitations of this study and we have inferred the main indications.
A. Veyssiere (&) N. Leprovost A. Caillot D. Labbe´ H. Benateau Department of Maxillo-facial and Plastic Surgery, University Hospital of Caen, Caen 14000, France e-mail: [email protected] J. Rod Department of Anatomy, University Hospital of Caen, Caen 14000, France A. Gerdom B. Lengele´ Department of Anatomy, University Clinic of St Luc., Catholic University of Louvain, Brussels 1200, Belgium
Keywords Temporal arteries Temporal muscle flap Anatomy Dissection Cadaver Angiography
Introduction The temporalis muscle is a masticatory muscle, bipennate, located in the temporal fossa of the temporal bone. Vascularization comes from three main pedicles: anterior deep temporal artery, posterior deep temporal artery (both collateral branches of the internal maxillary artery) and the middle temporal artery (a collateral branch of the superficial temporal artery) [11, 12]. The temporalis muscle flap was first described by Golovine [7] in 1898 for reconstruction of the orbit after exenteration. Since then, it has been widely used for this indication as well as for surgery of the skull base and reconstruction of oral cavity and oropharynx defects [1, 4, 6, 13]. In 1995, Kim [8] proposed splitting the temporalis muscle in the plane of the tendinous insertion lamina. This made it possible to increase the length of the flap and reach the midline, thus opening up new directions in cranio-facial trauma and substance loss. Two types of duplications are possible. Splitting the flap from the deep muscle layer with vascularization ensured by the superficial temporal pedicle; the deep muscular layer finds itself at the distal end of the
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