Temporal myofascial segmentation for multilayer reconstruction of middle cranial fossa floor after extradural subtemporal approach to the clival and paraclival region

Document Type

Journal Article

Publication Date

10-1-2019

Journal

Head and Neck

Volume

41

Issue

10

DOI

10.1002/hed.25896

Keywords

extradural subtemporal transzygomatic approach; pedicled flap; skull base reconstruction; temporal fascia flap; temporal muscle

Abstract

Background: Skull-base reconstruction represents a concern after resection of middle fossa (MF) tumors by the extradural subtemporal transzygomatic approach (ESTZ). Regional pedicled flaps appear to be the best option. This study describes a technique for temporal myofascial segmentation to harvest a multilayered vascularized flap for MF reconstruction, which might preserve temporal muscle (TM) function and its blood supply. Methods: The technique to harvest a combined segmented temporal myofascial flap (CSTMF) is described. The flap consists in a temporal fascial (TFF) and a muscle flap (TMF), composed by TM anterior-medial bundle (AMB). Results: CSTMF provides wide coverage of dural lining, through the TFF, and of dead-space, through the TMF. The possibility to tailor TMF according to the need, anatomically preserving the blood supply, enables to significantly increase its volume. Conclusion: CSTMF represents an effective option as regional multilayered pedicled flap for MF reconstruction, potentially preserving TM function and minimizing the cosmetic impact.

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