Efficacy of Temporalis Myofascial Flap as an Interpositional Graft ...
Efficacy of Temporalis Myofascial Flap as an Interpositional Graft ...
Efficacy of Temporalis Myofascial Flap as an Interpositional Graft ...
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<strong>Efficacy</strong> <strong>of</strong> <strong>Temporalis</strong> My<strong>of</strong><strong>as</strong>cial <strong>Flap</strong> <strong>as</strong> <strong>an</strong> <strong>Interpositional</strong> <strong>Graft</strong> ------- K Raj<strong>an</strong>ik<strong>an</strong>th, M K Gupta, P Sharma, A Pillai, K Gurumaterial between the remaining ramus <strong>an</strong>d skull b<strong>as</strong>e.It is necessary to use <strong>an</strong> interpositional material toprevent TMJ re-<strong>an</strong>kylosis after arthropl<strong>as</strong>ty (orcondylectomy). This particular <strong>as</strong>pect <strong>of</strong> the treatmenth<strong>as</strong> been the subject <strong>of</strong> numerous discussions. The use<strong>of</strong> various allogenic interpositional materials h<strong>as</strong> led toserious complications, including foreign body reaction<strong>an</strong>d migration. Homografts, such <strong>as</strong> skin, temporalismuscle, or f<strong>as</strong>cia lata, are considered <strong>as</strong> the material<strong>of</strong> choice for interposition.In recent years, a pedicled temporalismy<strong>of</strong><strong>as</strong>cial or temporal f<strong>as</strong>cia flap h<strong>as</strong> been advocatedin TMJ surgery to treat the TMJ <strong>an</strong>kylosis (Feinberg& Larsen, 1989). Adv<strong>an</strong>tages <strong>of</strong> these flaps in TMJreconstruction include close proximity to the TMJwithout involving <strong>an</strong> additional surgical site, adequateblood supply, autogenous origin, <strong>an</strong>d mainten<strong>an</strong>ce <strong>of</strong>attachment to the coronoid process which providesmovement <strong>of</strong> the flap during function, simulatingphysiologic action <strong>of</strong> the disc. Its proximity to the jointallows for a pedicled tr<strong>an</strong>sfer <strong>of</strong> v<strong>as</strong>cularized tissueinto the joint area. In this c<strong>as</strong>e a composite (f<strong>as</strong>cia,muscle, <strong>an</strong>d periosteum) axial flap w<strong>as</strong> harvested, <strong>as</strong>described by Herbosa & Rotsk<strong>of</strong>f (1990). The axialflaps were e<strong>as</strong>ily rotated inferiorly into the joint space.Rotation under the zygomatic arch prevents bulkiness<strong>an</strong>d avoids the need for surgically reducing the thickness<strong>of</strong> the zygomatic arch, <strong>as</strong> suggested by Pogrel & Kab<strong>an</strong>(1990), when rotating the muscle over the arch.Regarding the fate <strong>of</strong> temporalis muscle graft,Umeda et al (1993) have demonstrated by magneticreson<strong>an</strong>ce imaging that the flaps appeared to be viable<strong>an</strong>d the tissue signal w<strong>as</strong> compatible with vital muscle<strong>an</strong>d / or fat <strong>as</strong> opposed to tissue scarring.for M<strong>an</strong>agement <strong>of</strong> Temporo-m<strong>an</strong>dibular Joint Ankylosis.Journal <strong>of</strong> Oral <strong>an</strong>d Maxill<strong>of</strong>acial Surgery, 1990;48(11):1145-1151.5. Kaz<strong>an</strong>ji<strong>an</strong> VH: Temporo-m<strong>an</strong>dibular <strong>an</strong>kylosis withm<strong>an</strong>dibular retrusion. Americ<strong>an</strong> Journal <strong>of</strong> Surgery,1955;90: 905-910.6. L<strong>as</strong>kin DM: Role <strong>of</strong> the meniscus in the etiology <strong>of</strong> posttraumatic temporom<strong>an</strong>dibular joint <strong>an</strong>kylosis.International Journal <strong>of</strong> Oral Surgery, 1978;7(4):340-345.7. Lindqvist C, Pihakari A, T<strong>as</strong><strong>an</strong>en A, Hampf G: Autogenouscostochondral grafts in TMJ arthropl<strong>as</strong>ty. A survey <strong>of</strong>66 arthropl<strong>as</strong>ties in 60 patients. Journal <strong>of</strong> Maxill<strong>of</strong>acialSurgery, 1986; 14(3):143-149.8. Pogrel MA, Kab<strong>an</strong> LB: The role <strong>of</strong> a temporalis f<strong>as</strong>cia<strong>an</strong>d muscle flap in temporom<strong>an</strong>dibular joint surgery.Journal <strong>of</strong> Oral <strong>an</strong>d Maxill<strong>of</strong>acial Surgery, 1990; 48(1):14-19.9. Smith JA, S<strong>an</strong>dler NA, Ozaki WH, Braun TW: Subjective<strong>an</strong>d objective <strong>as</strong>sessment <strong>of</strong> the temporal my<strong>of</strong><strong>as</strong>cialflap in previously operated temporom<strong>an</strong>dibular joints.Journal <strong>of</strong> Oral <strong>an</strong>d Maxill<strong>of</strong>acial Surgery, 1999;57(9):1058-1065.10. Su-Gw<strong>an</strong> K: Treatment <strong>of</strong> temporom<strong>an</strong>dibular joint<strong>an</strong>kylosis with temporalis muscle <strong>an</strong>d f<strong>as</strong>cia flap.International Journal <strong>of</strong> Oral <strong>an</strong>d Maxill<strong>of</strong>acialSurgery, 2001;30(3):189-193.11. Umeda H, Kab<strong>an</strong> LB, Pogrel MA,Stren M, Rotsk<strong>of</strong>f KS:Long-term viability <strong>of</strong> temporalis muscle/f<strong>as</strong>cia flap usedfor temporom<strong>an</strong>dibular reconstruction. Journal <strong>of</strong> Oral<strong>an</strong>d Maxill<strong>of</strong>acial Surgery, 1993;51(5):530-534.Bibliography:1. Al kayat A, Bramley P: A modified pre-auricular approachto the Temporo-m<strong>an</strong>dibular joint <strong>an</strong>d molar arch. BritishJournal <strong>of</strong> Oral Surgery, 1979; 17:91-103.2. Feinberg SE, Larsen PE: The use <strong>of</strong> a pedicled temporalismuscle-pericr<strong>an</strong>ial flap for replacement <strong>of</strong> the TMJ disc:preliminary report. Journal <strong>of</strong> Oral <strong>an</strong>d Maxill<strong>of</strong>acialSurgery, 1989; 47: 142-146.3. Herbosa EG, Rotsk<strong>of</strong>f KS: Composite temporalis pedicleflap <strong>as</strong> <strong>an</strong> interpositional graft in temporom<strong>an</strong>dibularjoint arthropl<strong>as</strong>ty: a preliminary report. Journal <strong>of</strong> Oral<strong>an</strong>d Maxill<strong>of</strong>acial Surgery, 1990; 48(11): 1049-1056.4. Kab<strong>an</strong> LB, Perrott DH, Fisher K, Topazi<strong>an</strong> RG: A ProtocolPeople’s Journal <strong>of</strong> Scientific Research 8 Vol.2(2), July 2009
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