TEMPORALIS MUSCLE FLAP - Vula - University of Cape Town

3the soft tissues with a Langenbeckretractor. The two layers of deep temporalfascia are incised along the superiormargin of the zygoma (Figure 6).Figure 6: Mobilisation of temporalismuscle and exposure of zygomatic archThe temporalis muscle is elevated from thebone of the temporal fossa using eitherdiathermy or a periosteal elevator. Thedissection remains hard on the bone, andextends medial to the coronoid process ofthe mandible that is now readily palpablemedial to the zygoma, especially when themouth is closed (Figure 7).muscle and its origin from the coronoidprocess. With a thin muscle the flap cannow be passed through this tunnel into themouth, taking care not to rotate the flapand strangulate its blood supply. With abulky muscle, the zygomatic arch and/orthe coronoid process of the mandible maybe osteotomised to permit passage of theflap. The zygomatic bone can be kept insaline and plated/wired back later in theprocedure. The coronoid osteotomy is doneeither from above via the temporal fossa,or via the mouth. Great care has to betaken not to injure the deep temporalvessels by staying close to the bonysurface of the coronoid.Additional length of flap may be obtainedby transecting or resecting the coronoidprocess and thus freeing the origin of themuscle from the bone, or by using anextended myofascial flap that includesadditional temporalis fascia.Clinical ApplicationsThe temporalis muscle flap may be usedfor reconstruction of oral (floor of mouth,tongue, buccal, retromolar trigone, andpalate), oropharyngeal, nasopharyngeal,orbital, maxillectomy and facial soft tissuedefects.Palatal and maxillary resectionsFigure 7: Flap completely elevated fromtemporal fossaShould the flap need to be passed into theoral cavity, then a finger can now beentunnelled into the mouth medial to theThe flap is ideally suited to reconstructionof the palate following Le Fort 1maxillectomy (Figure 8), but alsofollowing total maxillectomy. Thecoronoid process of the mandible on whichit is a pedicled is immediately adjacent tothe defect. It may reach across the midline.The muscle is left bare in the mouth, andmucosalises within a matter of weeks.Bilateral palatal resection defects may bereconstructed with bilateral temporalismuscle flaps that are sutured together inthe midline.