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^® (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.

Temporalis muscle flap - cranial base - reconstruction

REFERENCES

• 1 Lentz J. Résection du col du condyle avec interposition d'un lambeau temporal entre les surfaces de résection. Guérison.  Assoc Franç de Chirur (Paris). 1895;  9 113-117
• 2 Golovine S S. Procédé de cloture plastique de l'orbite après l'exentération.  Arch Ophthalmol. 1898;  18 679-680
• 3 Rambo J H. Musculoplasty: a new operation for suppurative middle ear deafness.  Trans Am Acad Ophthalmol Otolaryngol. 1958;  62 166-177
• 4 Bakamjian V. A technique for primary reconstruction of the palate after radical maxillectomy for cancer.  Plast Reconstr Surg. 1963;  31 103-117
• 5 Cramer L M. Surgical management of recurrent periorbital tumors.  Plast Reconstr Surg Transplant Bull. 1962;  29 14-21
• 6 Bradley P, Brockbank J. The temporalis muscle flap in oral reconstruction: a cadaveric, animal and clinical study.  J Maxillofac Surg. 1981;  9 139-145
• 7 Koranda F C, McMahon M F, Jernstrom V R. The temporalis muscle flap for intraoral reconstruction.  Arch Otolaryngol Head Neck Surg. 1987;  113 740-743
• 8 Shagets F W, Panje W R, Shore J W. Use of temporalis muscle flaps in complicated defects of the head and face.  Arch Otolaryngol Head Neck Surg. 1986;  112 60-65
• 9 Maegawa J, Saijo M, Ogino H, Yamamoto I. Reverse U-shaped split temporalis musculofascial flap in cranial base reconstruction.  Ann Plast Surg. 1999;  42 644-650
• 10 Chang D W, Langstein H N, Gupta A et al.. Reconstructive management of cranial base defects after tumor ablation.  Plast Reconstr Surg. 2001;  107 1346-1355
• 11 Cheney M L. Temporalis. In: Urken ML, Cheney ML, Sullivan MJ, Biller HF Atlas of Regional and Free Flaps for Head and Neck Reconstruction. New York; Raven Press 1995: 65-76
• 12 Irish J C, Gullane P J, Gentili F et al.. Tumors of the skull base: outcome and survival analysis of 77 cases.  Head Neck. 1994;  16 3-10
• 13 Bull W J, Vandevender D, Cimino V G. Reconstruction of defects of the cranial base.  Tech Neurosurg. 2003;  9 106-112
• 14 Hanasono M M, Utley D S, Goode R L. The temporalis muscle flap for reconstruction after head and neck oncologic surgery.  Laryngoscope. 2001;  111 1719-1725
• 15 Bakamjian V Y, Souther S G. Use of the temporal muscle flap for reconstruction after orbito-maxillary resections for cancer.  Plast Reconstr Surg. 1975;  56 171-177
• 16 Holmes A D, Marshall K A. Uses of the temporalis muscle flap in blanking out orbits.  Plast Reconstr Surg. 1979;  63 336-342
• 17 Cordeiro P G, Wolfe S A. The temporalis muscle flap revisited on its centennial: advantages, newer uses, and disadvantages.  Plast Reconstr Surg. 1996;  98 980-987
• 18 Abubaker A O, Abouzgia M B. The temporalis muscle flap in reconstruction of intraoral defects: an appraisal of the technique.  Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;  94 24-30
• 19 Clauser L, Curioni C, Spanio S. The use of the temporalis muscle flap in facial and craniofacial reconstructive surgery: a review of 182 cases.  J Craniomaxillofac Surg. 1995;  23 203-214
• 20 Wolff K D, Dienemann D, Hoffmeister B. Intraoral defect coverage with muscle flaps.  J Oral Maxillofac Surg. 1995;  53 680-686
• 21 Colmenero C, Martorell V, Colmenero B, Sierra I. Temporalis myofascial flap for maxillofacial reconstruction.  J Oral Maxillofac Surg. 1991;  49 1067-1073
• 22 Falconer D T, Phillips J G. Reconstruction of the defect at the donor site of the temporalis muscle flap.  Br J Oral Maxillofac Surg. 1991;  29 16-18
• 23 Cheung L K, Samman N, Tideman H. The use of mouldable acrylic for restoration of the temporalis flap donor site.  J Craniomaxillofac Surg. 1994;  22 335-341
• 24 de Visscher J GAM, van der Wal K GH. Temporalis muscle flap revisited on its centennial: advantages, newer uses, and disadvantages [letter].  Plast Reconstr Surg. 1997;  100 1936-1938
• 25 Demas P N, Sotereanos G C. Transmaxillary temporalis transfer for reconstruction of a large palatal defect: report of a case.  J Oral Maxillofac Surg. 1989;  47 197-202
• 26 Huttenbrink K B. Temporalis muscle flap: an alternative in oropharyngeal reconstruction.  Laryngoscope. 1986;  96 1034-1038
• 27 Alonso del Hoyo J, Fernandez Sanroman J, Gil-Diez J L, Diaz Gonzalez F J. The temporalis muscle flap: an evaluation and review of 38 cases.  J Oral Maxillofac Surg. 1994;  52 143-147