The temporalis muscle: Its applications in maxillo-facial surgery ( Conference Paper ) [IL MUSCOLO TEMPORALE: SUOI IMPIEGHI IN CHIRURGIA MAXILLO-FACCIALE]

The temporalis muscle represents a precious reserve of vital and easily available tissue for reconstructive purposes in traumatic, neoplastic and malformative diseases of the cranio-facial area. Due to the anatomical and topographical characters, the plasticity and the contractile properties of the muscle, a flap based on it is an extremely effective alternative to other reconstructive procedures. Moreover the preparation of this flap is very easy and the complications connected with the procedure irrilevant. Nowadays the temporalis muscle flap can be employed as an interposition or reconstructive element and as donor of vascularized tissue. Moreover it can be used for dynamic purposes in facial paralysis or as a vascular pedicle for bone grafts (osteo-muscular temporalis flap). As an interposition element it is utilized in various diseases, surgically managed, of the temporo-mandibular joint (mainly ankylosis). Its main application is however in reconstruction of various anatomical areas of the cranio-facial region damaged by trauma, demolished for tumors, or imperfect for malformations. In this way the flap can be used as a muscular or as an osteomuscular flap. In the first case, despite the flap is constitued only by muscle, we can reconstruct areas deficient in soft and/or hard tissues (cheek, flour of the mouth, orbital contents, mandible, zygoma, base of the skull, palate etc.). When utilized as an osteo-muscular flap the muscle mainly represents the vascular pedicle of a graft, taken from the skull, employed for reconstruction of skeletal segments (mandible, zygoma, maxilla etc...). Then it is possible to exploit the contractile properties of the temporalis muscle for eyelid and oral commissure reanimation in old facial paralysis, when no nerve surgery can be carried out with predictable results. Finally the excellent vascularization of this flap is used to improve trophic conditions in areas with insufficient blood supply or trophic disorders (irradiated areas). The Authors, after a short recall about some interesting anatomical and surgical aspects of the temporalis muscle flap, present the main possibilities of its utilization, relating them to their personal experience ( 30 cases).