The Temporalis Muscle Flap for Palate Reconstruction: Case Series and Review of the Literature

Brennan, Tara; Tham, Tristan M.; Costantino, Peter

doi:10.1055/s-0037-1598653

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Original Research • Int. Arch. Otorhinolaryngol. 21 (03) • Jul-Sep 2017 • https://doi.org/10.1055/s-0037-1598653 copy

The Temporalis Muscle Flap for Palate Reconstruction: Case Series and Review of the Literature

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

The temporalis myofascial (TM) is an important reconstructive flap in palate reconstruction. Past studies have shown the temporalismyofascial flap to be safe as well as effective. Free flap reconstruction of palate defects is also a popular method used by contemporary surgeons. We aim to reaffirm the temporalis myofascial flap as a viable alternative to free flaps for palate reconstruction.

Objective

We report our results using the temporalis flap for palate reconstruction in one of the largest case series reported. Our literature review is the first to describe complication rates of palate reconstruction using the TM flap.

Methods

Retrospective chart review and review of the literature.

Results

Fifteen patients underwent palate reconstruction with the TMflap. There were no cases of facial nerve injury. Five (33%) of these patients underwent secondary cranioplasty to address temporal hollowing after the TM flap. Three out of fifteen (20%) had flap related complications. Fourteen (93%) of the palate defects were successfully reconstructed, with the remaining case pending a secondary procedure to close the defect. Ultimately, all of the flaps (100%) survived.

Conclusion

The TM flap is a viable method of palate defect closure with a high defect closure rate and flap survival rate. TM flaps are versatile in repairing palate defects of all sizes, in all regions of the palate. Cosmetic deformity created from TM flap harvest may be addressed using cranioplasty implant placement, either primarily or during a second stage procedure.

Keywords:
reconstructive surgical procedures; palate; temporal muscle

#	Age	Pathology	Type of Flap	Region	Size** (cm)	Flap related complications	Need for flap revision	Cranioplasty
1	46	Recurrent Ameloblastoma	TM	A/B	3	No	No	Yes
2	84	SCC	TM	B	4.5	No	No	No
3	61	ACC	TM	A/B	3	No	No	No
4	68	SCC	TM	B/C	4	No	No	No
5	46	ACC	TM	A/B	3	Residual fistula	Yes	No
6	47	Pleomorphic Adenoma	TM	A/B/C	6	No	No	No
7	51	ACC	TM	B	3	No	No	Yes
8	42	Mucoepidermoid Carcinoma	TM	B/C	3.5	No	No	Yes
9	64	Defect secondary to chronic cocaine abuse	TM	B/C, part of A	3.5	No	No	Yes
10	50	Adenocarcinoma	TM	B/C	3	Residual fistula*	Yes	No
11	68	ACC	TM	B	3	Trismus*	No	Yes
12	81	Defect Secondary to Iatrogenic Osteoradionecrosis	TM	b/l A/B/C	4	No	No	No
13	47	ACC	TM	B	1	No	No	No
14	75	Malignant Melanoma	TM	A/B	3	No	No	No
15	45	Adenocarcinoma	TM	A/B/C	4	No	No	No

#	Paper	Number of Patients	Complications/notes
1	Browne¹1 Browne JD, Butler S, Rees C. Functional outcomes and suitability of the temporalis myofascial flap for palatal and maxillary reconstruction after oncologic resection. Laryngoscope 2011;121(06): 1149-1159	72	3 (4.2%) Trismus, 4 (5.6%) Choanal stenosis, (1.4%) Ocular muscle entrapment, 21 (29.2%) Serous otitis media, 10 (13.9%) Temporal fossa infection. 31 (43%) patients had at least 1 complication
2	Krzymański¹⁸18 Krzymanski G, Dabrowski J, Przybysz J, Domanski W, Biernacka B, Pietka T. Temporal muscle flap in reconstruction of maxillo-facial tissues. Contemp Oncol (Pozn) 2012;16(03):244-249	3	2 (66%) oronasal fistula, managed with secondary suture
3	Abu-El Naaj¹⁹19 Abu-El Naaj I, Leiser Y, Liberman R, Peled M. The use of the temporalismyofascial flap in oral cancer patients. J OralMaxillofac Surg 2010;68(03):578-583	5	1(20%) necrotic flap, resolved after local debridement
4	Wong²⁰20 Wong TY, Chung CH, Huang JS, Chen HA. The inverted temporalis muscle flap for intraoral reconstruction: its rationale and the results of its application. J Oral Maxillofac Surg 2004;62(06):667-675	6	1 (16.7%) Cheek Fullness, 1 (16.7%) Cheek Depression, 2 (33.3%) Velopharyngeal Incompetance, 2 (33.3%) Siaolocele.
5	Abubaker⁶6 Abubaker AO, Abouzgia MB. 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(01): 24-30	8	No complications
6	Hanasono²¹21 HanasonoMM, Utley DS, Goode RL. The temporalismuscle flap for reconstruction after head and neck oncologic surgery. Laryngoscope 2001;111(10):1719-1725	2	No complications
7	Thomson²²22 Thomson CJ, Allison RS. The temporalis muscle flap in intraoral reconstruction. Aust N Z J Surg 1997;67(12):878-882	4	*
8	Cordeiro²³23 Cordeiro PG,Wolfe SA. The temporalis muscle flap revisited on its centennial: advantages, newer uses, and disadvantages. Plast Reconstr Surg 1996;98(06):980-987	24	*
9	Clauser⁵5 Clauser L, Curioni C, Spanio S. The use of the temporalismuscle flap in facial and craniofacial reconstructive surgery. A review of 182 cases. J Craniomaxillofac Surg 1995;23(04):203-214	3	*
10	Del Hoyo²⁴24 Alonso del Hoyo J, Fernandez Sanroman J, Gil-Diez JL, Diaz Gonzalez FJ. The temporalis muscle flap: an evaluation and review of 38 cases. J Oral Maxillofac Surg 1994;52(02):143-147, discussion 147-148	7	*
11	Van der Wal²⁵25 van der Wal KG, Mulder JW. The temporal muscle flap for closure of large palatal defects in CLP patients. Int J Oral Maxillofac Surg 1992;21(01):3-5	4 CLP	No complications
12	Colmenero²⁶26 Colmenero C, Martorell V, Colmenero B, Sierra I. Temporalis myofascial flap for maxillofacial reconstruction. J Oral Maxillofac Surg 1991;49(10):1067-1073	4	3 (75%) Trismus. Rest of complications not site specific
13	Tartan²⁷27 Tartan BF, Sotereanos GC, Patterson GT, Giuliani MJ. Use of the pharyngeal flap with temporalis muscle for reconstruction of the unrepaired adult palatal cleft: report of two cases. J OralMaxillofac Surg 1991;49(04):422-425	2 adult CLP	No complications

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[1] Address for correspondence Tara Brennan, MD. Assistant Professor, Facial Plastic & Reconstructive Surgery, Otolaryngology-Head & Neck Surgery, Department of Surgery, University of New Mexico, Albuquerque, New Mexico (e-mail: tristantham@gmail.com; ttham@northwell.edu).