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PubMed2001

Treatment of temporomandibular joint ankylosis with temporalis muscle and fascia flap.

This study sought to determine the efficacy of interpositional arthroplasty with temporalis muscle and fascia flap in the treatment of unilateral temporomandibular joint (TMJ) ankylosis in adults. This retrospective study of seven cases evaluated the postoperative results of interpositional arthroplasty on temporalis muscle and fascia flap in adults. The operative protocol for unilateral TMJ ankylosis entailed, (1) resection of ankylotic mass, (2) intraoral ipsilateral coronoidectomy, (3) contralateral coronoidectomy when necessary, (4) interpositional tissue transfer to the TMJ with temporalis muscle and fascia flap, (5) maxillomandibular fixation (MMF), and (6) early mobilization and aggressive physiotherapy. The results of this protocol were encouraging, while the functional results of interpositional arthroplasty on temporalis muscle and fascia flap were satisfactory. The findings of this study support the use of temporalis muscle and fascia flap in adult patients with unilateral TMJ ankylosis. Early postoperative initial exercise, physiotherapy, and strict follow-up play an important role in preventing postoperative adhesions.

Adult↗
PubMed1991

Differential activation of motor units in the wrist extensor muscles during the tonic vibration reflex in man.

1. Single motor unit activity was recorded in the extensor carpi radialis longus and extensor carpi radialis brevis muscles of five healthy human subjects, using metal microelectrodes. 2. Motor units were characterized on the basis of their twitch contraction times and their force recruitment thresholds during voluntary imposed-ramp contractions. 3. The discharge patterns of forty-three motor units were studied during tonic vibration reflex elicited by prolonged (150 s) trains of vibration (30 Hz) applied to the distal tendons of the muscles. The temporal relationships between the individual small tendon taps of the vibratory stimulus and the motor unit impulses were analysed on dot raster displays and post-stimulus time histograms. 4. After tendon taps, the impulses of motor units with long twitch contraction times (mean +/- S.D., 47.2 +/- 10.7 ms) and low recruitment thresholds (0.88 +/- 0.6 N) formed a single narrow peak (P1) with a latency (22.7 +/- 1.4 ms) which was comparable to that of the tendon jerk in the extensor carpi radialis muscles. These motor units were named 'P1 units'. On the other hand, the response of motor units with shorter twitch contraction times (31.1 +/- 3.3 ms) and higher recruitment thresholds (3.21 +/- 1.3 N) showed two peaks: a short latency (23.4 +/- 1.3 ms) P1 peak similar to the previous one and a P2 peak occurring 9.4 +/- 1.2 ms later. These motor units were named 'P1-P2 units'. 5. When the reflex contraction increased slowly, the P1 peaks of 'P1-P2 units' were clearly predominant at the beginning of the contraction, during the rising phase of the motor unit discharge frequency, while the P2 peaks became predominant when the units had reached their maximal discharge frequency. 6. Increasing the tendon vibration frequency (35, 55, 75, 95 Hz) did not modify the 'P1 unit' discharge pattern. Due to interference between vibration period and peak latencies, increasing the vibration frequency caused the P1 and P2 peaks of 'P1-P2 units' to overlap. 7. Superficial cutaneous stimulation of the dorsal side of the forearm during tendon vibration noticeably decreased the P1 peaks in both types of motor units. In the P2 peaks it could result in either a decrease or an increase but the average effect was a slight increase. 8. When applied 10 s before tendon vibration, cutaneous stimulation considerably suppressed the tonic vibration reflex.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1990

[Central giant cell granuloma of the maxilla].

We report the experience of the clinical, histologic and radiologic features of a giant cell granuloma of the maxilla of severe growth. The removal of the lesion led to a large defect of the maxilla with oroantral fistula, which was immediately repaired by the use of the temporalis muscle flap. A four year follow-up period revealed no evidence of recurrence as well as excellent aesthetic and functional results. Further diagnostic and therapeutic problems are discussed in relation with recent literature.

Aged↗
PubMed1991

Reconstruction of the defect at the donor site of the temporalis muscle flap.

A method for the immediate correction of the defect created at the donor site of the temporalis muscle flap is described. It uses a performed acrylic prosthesis. A case is presented in which the prosthesis could have been used to good effect, and two cases are reported to show the successful use of this technique.

Acrylic Resins↗
PubMed2006

The "yo-yo" technique to prevent cerebrospinal fluid rhinorrhea after anterior clinoidectomy for proximal internal carotid artery aneurysms.

OBJECTIVE: Resection of the anterior clinoid process is important for the exposure of aneurysms on clinoidal and supraclinoidal segments of the internal carotid artery. Cerebrospinal fluid (CSF) rhinorrhea can complicate anterior clinoidectomy when the optic strut is pneumatized and its removal communicates the subarachnoid space with the sphenoid sinus. We present a technique for repairing this defect and preventing CSF rhinorrhea. METHODS: A suture is secured around a strip of temporalis muscle, which is then pushed through the opening in the optic strut completely into the sphenoid sinus. The ends of suture that trail the muscle are used to retract the muscle from the sphenoid sinus back into the optic strut. The suture is trimmed and the repair is covered with sealant or fibrin glue. RESULTS: During an 8-year period in which 127 patients with proximal internal carotid artery aneurysms that required anterior clinoidectomy were treated, pneumatized optic struts were encountered in 14 patients (11%). Four patients were treated with the "yo-yo" technique, none of whom experienced CSF rhinorrhea. Before using this technique, 10 patients were managed with standard packing techniques (wax, muscle, and gel foam) and four of these patients subsequently experienced CSF rhinorrhea (40%). In these four patients, all required reoperation with either craniotomy and packing with pericranium (one patient), Couldwell-Luc procedure (one patient), or endoscopic transnasal obliteration of the sphenoid sinus with fat (two patients). CONCLUSION: The "yo-yo" technique of tightly wedging a muscle plug into the optic strut proved to be simple, fast, and effective, preventing CSF rhinorrhea in all patients in whom it was applied. Although experience with this technique is limited, reversing the direction of packing and pulling muscle from the sphenoid sinus into the optic strut eliminated a complication that occurred in 40% of patients with standard packing techniques.

Carotid Artery, Internal↗
PubMed1999

[Surgical management of the advanced orbit malignancies].

Twenty one patients with advanced malignant tumors of the orbit have been treated in the Department of Otolaryngology, Medical Academy in Warsaw, between 1980 and 1995. There were two groups of patients: five with primary orbital tumors and sixteen with secondary tumors that penetrated from sinuses. In all cases surgical treatment with orbital exenteration has been performed, as well as postoperative radiotherapy. The local cutaneus flaps and temporalis muscle flap have been used for reconstruction of the orbitomaxillary defects. The authors suggest that one-stage reconstruction of maxillo-facial region after surgery decreases facial deformation and allows to apply ocular prothesis guickly.

Carcinoma, Squamous Cell↗
PubMed2006

Report of ankylosis of the temporomandibular joint: treatment with a temporalis muscle flap and augmentation genioplasty.

A case of true bilateral ankylosis of the temporomandibular joint (TMJ) is presented. A 19-year-old male patient had a life-threatening ear infection at the age of ten resulting in a progressive restriction of his mouth opening. He presented with almost complete lack of mobility of the mandible. Surgical treatment was a resection of the ankylotic mass, interpositional temporalis composite muscle flaps, and early mobilization and aggressive physiotherapy. The functional results of the interpositional arthroplasty were excellent. After a two-year follow up, an augmentation genioplasty was performed in order to improve facial aesthetics.

Adult↗
PubMed1991

Fibromuscular temporalis graft implantation for rhinitis sicca.

A surgical technique is described of implanting temporalis fascia and muscle beneath the nasal mucosa to reduce nasal dryness and to attempt to normalize the nasal airflow in selected patients with rhinitis sicca secondary to prior nasal surgery. The surgical technique is described in detail and is illustrated in a case report.

Humans↗
PubMed1981

Myopathy associated with sclerodermal facial hemiatrophy.

A patient who had linear scleroderma associated with ipsilateral hemiatrophy of the tongue and subsequent facial hemiatrophy was studied. Biopsy specimens of the plaque of scleroderma showed the skin changes of scleroderma as well as fascial and muscle changes. The fascia had an impressive plasma cell fasciitis with numerous plasma cells and scattered lymphohistiocytic cells. Histochemical study of the temporalis muscle underlying the plaque of circumscribed scleroderma disclosed severe localized atrophy of type 1 and type 2 fibers similar to the pathologic findings previously described in a patient with localized scleroderma.

Adult↗
PubMed1996

Reconstructive myofascial skull-base flaps: normal appearance on CT and MR imaging studies.

On imaging studies, the tendon and fractured coronoid process are clues to the presence of a temporalis myofascial flap. A large, bulky muscle and subcutaneous fat are characteristic of a free flap with microvascular anastomosis. The enhancing, thin, curvilinear pericranial flap bridges an osseous defect of the anterior skull base. Familiarity with these features is essential to avoid misdiagnosis of normal flap as tumor and to identify tumor recurrence.

Humans↗
PubMedDate not supplied

Refinement in reanimation of the lower face.

Both the temporalis muscle transfer and the static sling procedure are techniques that improve deglutition, speech, and aesthetics in patients who are afflicted with paralysis of the lower part of the face. A refinement that is applicable to either of these procedures is described. By bringing the perioral attachment of either the muscle or the static sling exactly to the midline of the upper and lower lips, the surgeon can make the patient's mouth more symmetrical. This simple refinement will improve the results obtained with either procedure and has not been associated with any increased perioperative risks or complications.

Aged↗
PubMed1993

Immediate reconstruction following maxillectomy: a new method.

A new method for immediate reconstruction of the maxilla after resection is described. The ipsilateral pedicled temporalis muscle is tunneled into the defect and sagittaly split into two layers. The inner layer is used to line the nasal side. An individually shaped titanium mesh, tightly filled with free autogenous corticocancellous bone, is fixed by titanium screws to the remnant of the zygoma and contralateral maxilla. The outer layer of the split muscle covers the reconstruction, the temporalis fascia forming the oral side. The method resulted in good cosmetic appearance and permitted the re-creation of a maxillary alveolar ridge suitable for endosseous implants or a simple prosthesis.

Adolescent↗
PubMed2001

A trigeminal neuralgia-like paroxysmal pain condition presumably due to buccal nerve compression in the temporalis muscle.

We encountered three patients with trigeminal neuralgia-like paroxysmal pain in the buccal nerve region. In all cases, paroxysmal pain was felt spreading to the receptive field of the ipsilateral buccal nerve, and clear tenderness was observed during intraoral palpation at the inner side of the mandibular ramus where the temporalis muscle runs and attaches. It was assumed that the paroxysmal pain might be caused by nerve compression related to temporalis muscle hyperactivity. To lend support to this hypothesis, we also studied the anatomical relationship between the buccal nerve and the masticatory muscles. In this autopsy study, the buccal nerve pierced the temporalis muscle in six (12%) of 52 specimens from 26 cadavers. These findings support the hypothesis that peripheral buccal nerve compression could be an etiology of paroxysmal neuropathic pain in the unilateral orofacial region.

Aged↗
PubMed1993

Temporalis muscle for facial reanimation. A 13-year experience with 224 procedures.

A procedure for temporalis muscle transposition was used to reanimate the paralyzed face in 219 patients. In most cases, facial paralysis had followed an operation to remove an acoustic tumor. Analysis of the results showed this procedure to be highly successful and the method of choice, alone in cases of long-standing facial paralysis or to augment the effects of facial nerve grafting or hypoglossal-facial nerve anastomosis, in reanimating the mouth. It was successful in restoring a smile to 80% of the 219 patients and provided overall improvement in mouth function in 96%. Complications occurred in 21% of patients, with the most common being infection (12% of patients). Since one of us began to use the procedure to reanimate the eye and mouth, results of temporalis muscle transposition have been improved by the following: (1) using the procedure to reanimate the mouth only; (2) performing revision surgery, most often tightening the corner of the mouth (25% of patients), as indicated; (3) transposing only the midsection of the muscle; (4) implanting a prefabricated Silastic prosthesis to fill the muscle defect; (5) when indicated, lengthening the muscle with polytef (Gore-Tex+); and (6) placing the muscle in a tunnel lateral to the superficial musculoaponeurotic system to avoid injuring the underlying facial nerve should some spontaneous recovery of facial nerve function be possible.

Adolescent↗
PubMed2006

Functional upgrading of partially recovered facial palsy by cross-face nerve grafting with distal end-to-side neurorrhaphy.

BACKGROUND: Cross-face nerve grafting combined with functional muscle transplantation has become the standard in reconstructing an emotionally controlled smile in complete irreversible facial palsy. A special problem exists in incomplete or partially recovered facial palsies, when the little existing function should be preserved but the existing function alone is clinically insufficient. METHODS: In this situation, cross-face nerve grafting performed by means of end-to-end coaptation to a zygomatic branch of the healthy side and by end-to-side neurorrhaphy to a corresponding branch of the incompletely paralyzed side is proposed to upgrade smile function on the latter side and contribute to more static and dynamic overall symmetry. The interposition nerve graft is set in overlength to preserve the possibility of a later muscle transplantation in case of unsatisfying functional result through the additional neuronal input. The authors have used this concept in seven patients with irreversible partial facial palsy. Three cases have a sufficiently long follow-up to be presented here. Outcome was objectively quantified with three-dimensional video analysis of facial movements. RESULTS: In all three cases, functional improvement and a positive effect on the static and dynamic symmetry of the face could be measured. None of the patients was disappointed by the smile function achieved or wanted to undergo additional muscle transplantation. CONCLUSION: On the basis of these first clinical experiences, the authors recommend cross-face nerve grafting with overlength and a distal end-to-side neurorrhaphy in patients with irreversible incomplete facial palsy affecting the smile.

Adult↗
PubMed1989

[Resection of invasive orbital tumors and reconstruction with temporalis muscle flap].

3 patients with invasive basal cell carcinoma of the skin which necessitated orbital exenteration are reported. In all 3 treatment was delayed, primary therapy was inadequate and the tumor had reached massive size. Excision of the orbital contents is a radical, mutilating procedure, but in advanced cases of malignant orbital tumors it offers the only chance for survival. The temporalis muscle flap is adaptable, well supplied with blood, and contains a large mass of tissue. Its utilization provides a simple, uncomplicated and effective technique for orbital reconstruction following massive resection. It gives a relatively effective result which is usually acceptable to the patient.

Aged↗
PubMed1985

Use of temporalis fascia in eyelid reconstruction.

Full-thickness eyelid defects resulting from trauma, tumor destruction, surgical excision, or congenital anomalies present a dilemma to the reconstructive surgeon. Full-thickness eyelid replacement requires composite grafting of skin, muscle, tarsal support or its substitute, and mucosa. A temporalis fascia sling hammock can be used to support the reconstructed eyelid. This static suspension assists in maintaining proper globe apposition to the eyelid and in preventing sagging of the reconstructed structures.

Basal Cell Carcinoma↗
PubMed1997

Waking and sleeping temporalis EMG levels in tension-type headache patients.

Temporalis muscle activity in tension-type headache subjects (n = 36) and in matched nonheadache controls (n = 36) was evaluated in this study. Subjects' cumulative temporalis muscle activity was recorded every 30 minutes for 3 days and night using an electromyographic recorder. Analysis of variance showed that neither the waking nor the sleeping overall muscle activity levels for these two groups were statistically different. When the waking EMG data were dichotomized into function and nonfunction activities, a significant difference was found between groups during jaw function (i.e., chewing and talking). These data suggest that headache subjects are using their temporalis muscles with less efficiency than nonheadache subjects during function. This elevated EMG is more likely a consequence of pain (via protective splinting or guarding) rather than a cause in tension-type headache sufferers.

Adult↗