This personal view is based on a new classification of. Within head and neck reconstruction, the flap probably has been used most extensively in orbital and maxillary reconstruction. Jul 29, 2010 most patients requiring midface reconstruction have had ablative surgery for malignant disease, and most require postoperative radiotherapy. As it is a very aggressive surgery, the aesthetic and functional. 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. There were no complications related to the reconstruction. Cosmetic and reconstructive procedures page 4 of 7 unitedhealthcare oxford clinical policy effective 01012018 19962018, oxford health plans, llc cpt code description 21179 reconstruction, entire or majority of forehead andor supraorbital rims. Titanium orbital mesh plates synthes orbital floor mesh plates recommended for all types of orbital fractures and reconstruction of the bony orbit. Autogenous corticocancellous bone grafts were used in the orbit as a volume filler. 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. The main concerns stemming from in this procedure are the creation of adequate tumorfree margins and the preservation of as much normal periocular soft tissue as possible for reconstruction. Temporalis flap for upper and lower eyelid reconstruction. Temporalis musclecoronoid swing and forehead skin island flap.
Temporalis pedicled rotation flap for orbital floor reconstruction of the total maxillectomy defect pryor 2004 the laryngoscope wiley online library. We have used flaps consisting of temporoparietal fascia, combined deep temporal fascia,andorportionsoftemporalismuscle,all with associated vascularized calvarial bone. In further years the flaps from temporal muscle became widely used in tissue reconstruction following extensive oncologic procedures around base of the skull, orbital, maxillary resection, zygomaxillary complex as well as for reconstructing defects of soft tissue in oral cavity and throat 112. Jan 19, 2019 the temporalis myofascial flap tmff is a locally available, safe and reliable flap which can be used for the reconstruction of various orbital and supramaxillary facial defects. The temporalis myofascial flap tmff is a locally available, safe and reliable flap which can be used for the reconstruction of various orbital and supramaxillary facial defects. Temporalis myofascial flap tmf and immediate soft tissue. Temporal muscle flap in reconstruction of maxillofacial tissues. Original article temporalis muscle flap for reconstruction of skull base defects jesse e. Features radial design simplifies cutting malleable material facilitates contouring three rows of screw holes provide a variety of fixation points to adapt to orbital anatomy. Due to the good clinical evolution, a reconstruction of the orbital exenteration defect was performed in case 1 with a temporal muscle flap and a skin island pedicled flap. Following tumor removal the fasciamuscle flaps of temporal muscle were used for reconstruction. A oneside pedicled temporalis osteomyoperiosteal flap is used for reconstruction of oral and nasal lining, maxillary bone, and oral, as well as nasal, soft tissue lining of the velum. Objective to describe a novel surgical technique for ventral orbital reconstruction after ventral orbitectomy by using a temporalis fascia transposition flap.
Variables examined include the location of defects, the success of flap survival in orbital cavities after primary or secondary. Bifurcated superficial temporal artery island flap for the. Smith, md,1,2 yadranko ducic, md, frcsc,1,2,3 robert t. A variety of island flaps can be based on the superficial temporal artery with variable tissue composition.
Seventytwo patients underwent facial reconstruction using a superficial temporal artery island flap from october 2010 to october 2014. Temporoparietal fascial flap in orbital reconstruction amy lai, md. Pdf reconstruction of the orbit with a temporalis muscle flap. Background a variety of island flaps can be based on the superficial temporal artery with variable tissue composition. Anterior cranial base reconstruction with a reverse. A cadaver dissection and report of two cases luther h. Small defects of the forehead can be closed in a fusiform manner, but a long incision is often required to avoid standing cones at either end. The temporoparietal fascial flap is useful for the reconstruction of regional defects involving the ear, orbit or cheek. The epithelialization over the oral portion of the muscle is completed in 4 to 6 weeks 8.
Therefore, an extended temporalis flap, including the parietal galeal flap, was elevated for skull base reconstruction. The study showed that temporalis muscle flap can provide a. The temporalis muscle flap is a versatile and reliable myofascial regional flap that can be used for reconstruction of many craniofacial defects due to its close vicinity to the orbit, oral cavity, and anterior and lateral skull base. To study the use of the temporalis myofascial flap in the reconstruction of various orbital.
Recent trends seem to favor free flap reconstruction for hard palate defects, when the temporoparietal fascial tpf flap or temporalis muscle tm flap are viable options affording a quicker, more efficient alternative for reconstruction. The prefabricated temporal island flap for eyelid and eye socket reconstruction in total orbital exenteration patients a new method muzaffer alt. Difficulty is encountered when the medial wall and orbital floor are completely removed and a temporalis musclecoronoid swing. Adequate exposure for raising this flap was obtained using standard incisions for the otologic procedures. This flap may also be harvested as a free flap for use in remote sites. Figure 4 both flaps were supplied by distinct arteries and therefore had increased chances of survival. Its main utility in head and neck reconstruction is for patients with multiple.
Introduction the maxillofacial region provides unlimited possibilities for the use of local and regional flaps. The temporalis muscle coronoid swing has been used to reconstruct the orbital floor and is described in literature as early as 1983. The temporalis muscle flap is readily used to close the defect after orbital exenteration, and does not prevent the detection of recurrence. The flap may be used as a turndown flap to cover auricular skin defects or to cover the cartilaginous framework of a reconstructed ear. Temporalis myofascial flap for primary cranial base. The addition of vascularised calvarial bone to the temporalis flap could also provide highquality bone for rigid orbital support in these patients. A composite musclebone flap of temporal muscle and coronoid process fills the defect satisfactorily and provides good support for the globe. Twentyfour patients with severe anophthalmic orbit syndrome were treated with a combination of techniques utilizing autogenous tissue.
In case 2, reconstruction was not performed due to the poor evolution of the patient. Conclusion the temporalis muscle flap is readily used to close the defect after orbital exenteration, and does not prevent the detection of recurrence. This technique confers multiple advantages in reducing the arc of rotation and providing a tensionfree reconstruction of the orbital skull base. The prefabricated temporal island flap for eyelid and eye. Methods seventytwo patients underwent facial reconstruction using a superficial temporal artery island flap from october 2010 to october 2014. Covered with a tpf flap based on parietal branch of superficial temporal artery. Temporoparietal fascial flap in orbital reconstruction oncology. Adelson, md4 1department of otolaryngologyhead and neck surgery, university of texas southwestern medical center. Moreover, this flap places the facial nerve at risk, particularly in the upper division, and results in the unnatural appearance of a temporal depression. Pdf reverse temporalis muscle flap for the reconstruction.
Vascularized calvarial bone flaps and midface reconstruction. The authors present a method for reconstruction of the orbital floor and discuss the advantages and disadvantages of this method. For reconstruction of extra oral defects, skin grafting is usually needed to cover the muscle. Reconstruction of midfacial defects using temporalis muscle flap. Reconstruction of the orbital floor with the musclebone flap. Orbital exenteration defects to provide skin cover in combination with muscle flaps e. In head and neck surgery, orbital exenteration is commonly used to treat skin, nasal cavity, and paranasal sinus malignancies. The temporoparietal fascial flap and the temporalis muscle. Opting for a regional flap over a free flap also avoids the. 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. Below the superior margin of the orbit, it separates into. Coronoid temporalis pedicled rotation flap for orbital floor reconstruction of the total maxillectomy defect shepherd g.
Pdf superficial temporal artery flap for reconstruction. These defects resulted from resection of invasive periorbital skin tumors, maxillectomy and orbital exenteration. The buccal fat pad flap for periorbital reconstruction. Developments in reconstruction of midface and maxilla the. After orbital reconstruction, various ocular prostheses can be used as requested by the patient, including hydroxyapatite implants, polymethylmethacrylate prostheses, and boneimplanted dentures 14,15. It has been described for isolated upper eyelid defects 24 and orbital reconstruction 512. Keywords regional flap reconstruction of the orbital floor musclebone flap.
Small skin defects, 12 cm, of the epithelium will migrate over the exposed flap with wet to dry dressings changes. Temporal muscle flaps were applied in 5 cases for reconstructing the defect of eye socket tissue after extensive resections and in the other 5 patients was used for reconstructing the defect of palate following maxillary resections. Temporalis flap for the maxillary defect reconstruction. Palatal and maxillary resections the flap is ideally suited for reconstruction. The group, who had defects involving orbital removal and less than 30% of the bony orbital rim, received reconstruction with the osseocutaneous forearm flap. A large amount of thin tissue is readily available. Reconstruction of orbital suprastructure maxillectomy. Methods a retrospective nonrandomized study of orbital exenterations performed between 1990 and 2010 for malignant tumors of the skin, paranasal sinus, and nasal cavity is presented. In this article, the authors present a new modification of the use of the temporalis muscle flap for orbital skull base reconstruction with the use of a sphenoid keyhole. The temporalis muscle flap could not be advanced to the center of the frontal sinus. To evaluate the success of the temporopa rietal fascial flap tpff in the primary or secondary re. The temporalis muscle flap was preferred for reconstruction in this study. The temporoparietal fascial flap was tunneled under a skin flap extending from the hairbearing temporal scalp to the area of defect.
Use of a transorbital temporal muscle flap, abstract orbital exenteration is a disfiguring operation that involves the total removal of the orbital contents with partial or total excision of the eyelids. Reconstruction of orbital suprastructure maxillectomy defects. A fullthickness temporalis myofascial flap tmf was used in all patients, maxillary and orbital floor reconstruction after hemimaxillectomy was accomplished in three patients, soft tissue reconstruction after maxillary resection and radiation in one patient, soft tissue reconstruction of the mandible in three. Flaps were developed at an early stage of the operation that involved a cranioorbital. Coronoidtemporalis pedicled rotation flap for orbital. Results the study included patients nine men, four women. As an alternative a temporalis muscle flap may be used in combination with a pericranial flap when a more bulky reconstruction of the orbital area is needed.
The orbital cavity was repaired with a temporalis muscle flap in all cases. Background the purpose of this study is to evaluate the outcome of orbital floor reconstruction with free flaps after maxillectomy methods this was a retrospective analysis of 34 consecutive patients who underwent maxillectomy with orbital floor removal for malignancies, reconstructed with free flaps. Orbital skull base reconstruction with temporalis muscle. Anterior cranial base reconstruction with a reverse temporalis muscle flap and calvarial bone graft seung gee kwon, yong oock kim, dong kyun rah institute of human tissue restoration, department of plastic and reconstructive surgery, yonsei university health system, severance hospital, yonsei university college of medicine, seoul, korea.
Reconstruction of the orbit with a temporalis muscle flap after orbital exenteration article pdf available in clinical and experimental otorhinolaryngology 81. Lateral orbital propeller flap technique for reconstruction of the lower eyelid defect jp ding1, b chen2,jyao3 1department of plastic surgery, beijing hospital, national center of gerontology, beijing, china 2department of plastic and reconstructive surgery, plastic surgery hospital, chinese academy of medical sciences and peking union medical college, beijing, china. This fascial flap provides a wide surface area of tissue on a narrowbased pedicle capable of a wide arc of rotation. Four cases are presented to illustrate possible variables in orbital reconstruction.
Cosmetic and reconstructive procedures page 2 of 7. Presents our experience in reconstruction of postsurgical defects with use of temporal muscle flap. Temporalis flap for the maxillary defect reconstruction youtube. Reconstruction of orbital exenteration defects by primary. Extended temporalis flap for skull base reconstruction. Pdf reconstruction of the orbit with a temporalis muscle. Temporal muscle flap in reconstruction of maxillofacial. Pdf reverse temporalis muscle flap for the reconstruction of.
Common methods of orbit reconstruction include pectoralis musculocutaneous pedicled flap and free tissue transfer. Most patients requiring midface reconstruction have had ablative surgery for malignant disease, and most require postoperative radiotherapy. Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra. Two patients underwent bilateral periorbital flap reconstruction. Reconstruction of the orbital floor with the musclebone. Superficial temporal artery flap for reconstruction of. The authors have used this flap for orbital reconstruction after exenteration in 6 patients with successful results.
Temporoparietal fascia flap iowa head and neck protocols. Reverse temporalis muscle flap for the reconstruction of. Difficulty is encountered when the medial wall and orbital floor are completely removed and a temporalis musclecoronoid swing is rendered insufficient for orbital reconstruction. Orbital floor reconstruction with free flaps after. Developments in reconstruction of midface and maxilla. Introduction orbital exenteration is a highly disfiguring procedure which, although providing local control of invasive orbital malignancy also results in marked visual, psychological and social disability. Use of a temporalis fascia transposition flap for ventral. The use of local regional flaps is often the most practical and easy means of reconstruction in the management of head and neck tumors. By contrast, patients who only had cavities where the orbit had been removed received reconstruction with fasciocutaneous forearm flaps. The purpose of this study is to illustrate that the entire temporalis muscle may be used by creating a large window in the lateral orbit, without resection of the lateral orbital rim. A retrospective nonrandomized study of orbital exenterations performed between 1990 and 2010 for malignant tumors of the skin, paranasal sinus. A technique for onestage reconstruction for bony and soft tissue repair after subtotal bilateral maxillectomy is reported. Atrophy of the temporalis muscle can result after dissection and reattachment with pterional and cranio orbital craniotomies. Reconstruction of the orbit with a temporalis muscle flap after.
Temporalis pedicled rotation flap for orbital floor. Orbital reconstruction was done using a coronoidtemporalis pedicled flap tcs anchored to the lateral orbital wall remnant, and an island forehead flap ff sutured to the temporalis muscle. To study the use of the temporalis myofascial flap in the reconstruction of various orbital and supramaxillary facial defects. When the orbital content is also removed, the combination of the pericranial and temporoparietal fascial flap can be used to repair this defect. To describe the techniques and outcome of three different approaches to transfer the posterior 23rd temporalis muscle pedicle flap for orbital socket reconstruction following total orbital. We successfully used reverse flow temporalis muscle flap for the purpose of eliminating the abovementioned disadvantage of temporalis muscle flap in a 23yearold male patient who sustained a highvoltage electrical burn resulting 12. Aug 09, 2017 temporal fascia medical animation gross anatomy of head and neck, dr g bhanu prakash duration.
Objectives this study presents the role of the temporalis muscle flap in primary reconstruction after orbital exenteration. They can be used for defect reconstruction, cavity resurfacing, facial hair restoration, or contracture release. Aesthetic considerations in the reconstruction of the. Bhanu prakash usmle, fmge and neet pg 16,856 views. Anophtalmic socket reconstruction is a challenging problem in plastic surgery. Two patients underwent successful reconstruction of the orbital floor with a coronoid. Reconstruction of the temporalis muscle for pterional and. Clinical articel efficacy of temporalis myofascial flap as an interpositional graft material in the management of tmj ankylosis. Temporalis reconstruction details the temporalis muscle was accessed via the same coronal incision utilized for the surgical resection figure 3 the use of a pericranialtemporoparietal fascial. Temporoparietal fascial flap in orbital reconstruction. Orbital floor reconstruction with pedicled buccal fat pad. Jul 06, 2012 presents our experience in reconstruction of postsurgical defects with use of temporal muscle flap.
Efficacy of temporalis myofascial flap as an interpositional. Successful reconstruction of the deficit requires repair of the orbital floor to preve. Adelson, md4 1department of otolaryngologyhead and neck surgery, university of texas southwestern medical center, dallas, texas. We present three consecutive total exenteration cases over 1 year where all 3, including extended exenteration defects, were repaired by primary closure by way of cheek advancement. In the years 19962010 we treated 10 patients with malignant neoplasms of maxillofacial region. The temporalis osteomyoperiosteal flap its blood supply and. This type of facial reconstruction attracts controversy, not only because of the many reconstructive options, but also because dental and facial prostheses can be very successful in selected cases. To describe a combination of forehead island flap and temporalis musclecoronoid swing in orbital reconstruction. All patients underwent periorbital reconstruction using a bifurcated superficial temporal artery island flap to reconstruct the eyebrows, correct the lagophthalmos, and release the ectropion in both the upper and the lower eyelids. Flaps were developed at an early stage of the operation that involved a cranio orbital. We illustrate modifications of these flaps for use in threedimensional orbital reconstruction. Reconstruction of the orbit with a temporalis muscle flap. Pdf this study presents the role of the temporalis muscle flap in primary reconstruction after orbital exenteration. Cadaver dissections, injection studies, and histological investigations were performed.
Versatility of temporal muscle and fascial flaps journal of plastic. High voltage electric burn repair of the forehead by reverse. The temporalis flap is a common flap used in head and neck reconstruction. This study presents the role of the temporalis muscle flap in primary reconstruction after orbital exenteration. Reconstruction of midfacial defects using temporalis. Temporalis musclecoronoid swing and forehead skin island. To prevent this sequel, a number of surgical modifications have been used to preserve the deep temporal nerve and artery, and also to allow for reconstruction of the temporalis muscle with minimal damage. Both patients display acceptable functional and cosmetic results. The temporalis muscle and a fasciae flap with a pericranial flap were used as a curtain to cover the bone grafts and to give a softening effect. The temporalis muscle is supplied by the middle temporal artery as it arises from the sta at the level of the zygomatic arch. Immediately after the extirpative procedure, the patient underwent reconstruction with a right temporoparietal fascial flap, splitthickness skin graft, and local cheek advancement flaps.