Osseous autografts covered with temporalis fascia: looking for greater survival.
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Animals↗
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Posttraumatic epidermal inclusion cyst of the deep infratemporal fossa.
The authors report a case of an epidermal inclusion cyst found in the deep infratemporal fossa 12 years after the patient sustained blunt trauma to that region. Posttraumatic epidermal inclusion cysts are rare and occur mainly in the fingers, palms, and soles. Introduction of the epidermal elements into the dermis during the trauma is thought to be the cause. This case is rare in presentation, with few reports in the English literature that describe an epidermal inclusion cyst in the deep infratemporal fossa. Review of the English literature disclosed no other cases of epidermal inclusion cyst after blunt trauma involving the deep infratemporal region.
Adult↗
Microscrew anchorage techniques in craniofacial surgery.
An adjunctive technique for fixation of soft tissue and alloplastic materials in craniofacial reconstruction by employing microscrews is presented.
Acrylic Resins↗
Prevention of "temporal hollowing" after fronto-orbital advancement for craniosynostosis.
Depression of profile in the temporal region is commonly seen after orbital rim advancement procedures. A newly developed temporalis musculoosseous flap has been designed with the intent to prevent this postoperative occurrence.
Craniosynostoses↗
Pneumocephalus caused by fistulas of the mastoid air cells treated with a temporoparietal fascial flap.
Using a temporoparietal fascial flap and hydroxyapatite ceramics, we treated a patient for complications after a neurosurgical operation for glossopharyngeal neuralgia. These consisted of pneumocephalus and cerebrospinal fluid rhinorrhea resulting from fistulas of mastoid air cells associated with a subcutaneous dead space. By means of the temporoparietal fascial flap, we were able to fill the dead space and reinforce the repaired dural and mastoid lesion as well. Hydroxyapatite ceramics were also useful for closing the mastoid air cell fistulas.
Bone Diseases↗
Subgaleal versus subperiosteal dissection in fronto-orbital advancement procedures.
Extensive cranioorbital surgery for craniosynostosis in young children can produce excessive blood loss. Thus, to overcome the disadvantage of unappropriated blood loss and translocation of the osteosynthesis material, we performed a subgaleal dissection in infants and compared the subperiosteal with the subgaleal surgical approach in 29 children who underwent surgery for craniosynostosis. The treatment goal of correction of the deformity was accomplished in each case. Fronto-orbital deformities were significantly improved in all patients. Blood loss was less in the group with subgaleal elevation of the forehead (mean = 163 ml) compared with the subperiosteal group, which had a mean 266 ml blood loss. The subgaleal dissection caused less bleeding and tethering of the advanced bone.
Blood Loss, Surgical↗
Clinical implications of the innervation of the temporomandibular joint.
The successful management of temporomandibular joint (TMJ) pain remains elusive. Often, the initial relief of pain is complicated by recurrence of the symptoms. This time frame suggests that the pain may be related to neuromas of the nerves that innervate the TMJ. The current study attempted to define the innervation pattern of the TMJ as identified in 16 embalmed and 8 fresh-frozen specimens. In each specimen, the auriculotemporal nerve, a branch of the mandibular portion (V3) of the trigeminal nerve, was found to innervate the lateral capsule of the TMJ. In 75% of the specimens, the masseteric nerve, a branch of the maxillary portion (V2) of the trigeminal nerve, was found to innervate the anteromedial capsule of the TMJ. In 33% of the specimens, there was a branch coming through the mandibular notch to innervate the anteromedial capsule that was not from the masseteric nerve; this nerve is believed to have passed through the lateral pterygoid muscle after leaving V2. These consistent patterns of innervation of the TMJ suggest that diagnostic nerve blocks can be done to determine the pain pathway in these patients. It is suggested that if the nerve blocks are successful, TMJ denervation may be a future method of pain relief in patients with recalcitrant or recurrent TMJ pain.
Cadaver↗
Zygomaticotemporal nerve passage in the orbit and temporal area.
Injury of the zygomaticotemporal nerve causes paresthesia in its distributed area, and its entrapment induces protractive pain in case of manipulation of the orbital lateral wall, a Gillies or Dingman reduction procedure for a zygomatic fracture, or an endoscopic subperiosteal facelift. The aim of this study was to elucidate the surgical anatomy of the zygomaticotemporal nerve in the orbit and temporal area. Twenty hemifaces from 10 adult Korean cadavers (10 male and 10 female) were used in the study. The zygomaticotemporal nerve ran along the lateral wall of the orbit, passed through the zygomaticotemporal foramen, and reached to the temporal fossa. The point where the zygomaticotemporal nerve appears at the margin of zygomatic bone is defined as the vulnerable point (Vp); hence, the nerve might be injured during surgical procedures. The Vp was 11.29 +/- 2.65 mm below the zygomaticofrontal suture and 21.76 +/- 2.76 mm from the superior border of zygomatic arch. The most vulnerable points were within a 10-mm diameter circle (vulnerable zone). Its center was 11 mm from the zygomaticofrontal suture at an angle of 45 degrees inferolaterally. The zygomaticotemporal nerve ran between the deep layer and the superficial layer of the deep temporal fascia. It ran just superficial to the deep layer of the deep temporal fascia toward the temporal area and innervated the temporal skin. The area innervated by terminal branches of the zygomaticotemporal nerve included a circle with 30-mm diameter, with the center located 10 mm superior to the top of the auriculocephalic sulcus and 30 mm lateral to the lateral canthus. Precautions should be taken when working in the area of the vulnerable zone during the Dingman procedure involving periorbital incision in case of zygomatic fracture.
Adult↗
Chronic expanding hematoma in the temporal region.
A rare case of chronic expanding hematoma in the right temporal region that developed into a large mass over the course of 12 years is reported. The patient, who had a history of blunt trauma to her right temporal region at the age of 4 months, noticed a slowly growing mass at the same site over the last few months. Computed tomography revealed a well-circumscribed subcutaneous tumor. The tumor was completely resected. Histopathologically, the diagnosis of chronic expanding hematoma was confirmed.
Child↗
Temporomandibular joint bony ankylosis: comparison of treatment with transport distraction osteogenesis or the matthews device arthroplasty.
Temporomandibular joint (TMJ) bony ankylosis with micrognathia is a rare congenital condition that is difficult to treat and may result in recurrence. In a series of affected patients, we compared two new methods of treatment: transport distraction osteogenesis and Matthews Device arthroplasty. All patients had computed tomography scan documented bilateral TMJ bony ankylosis. Group I (transport distraction osteogenesis) underwent distraction advancement of the mandible (for micrognathia) followed by resection of the condyles, recontouring of the glenoid fossas with interposition temporoparietal-fascial flaps, and transport distraction osteogenesis of mandibular rami segments. Group II (Matthews Device arthroplasty) underwent all of the above procedures except for transport distraction osteogenesis. Instead, the Matthews Devices were anchored to the temporal bone and mandibular rami. Hinged arms allowed for motion at the reconstructed TMJ. In both groups, patients underwent extensive postoperative therapy. Preoperative, postoperative, and follow-up lateral cephalograms were obtained, and incisor opening distances were recorded. All patients but one had severe micrognathia (n = 9). For group I (transport distraction osteogenesis), mean age was 6.8 years. and mean advancement was 28.5 mm. For group II (Matthews Device arthroplasty) mean age was 8.2 years, and mean advancement was 23.5 mm. In group I (transport distraction osteogenesis), mean incisor opening was 1 mm preoperatively and 27.5 mm postoperatively; however, it relapsed to 14.3 mm by 12.5 months follow-up (48% relapse). Mean incisor opening in group II (Matthews Device arthroplasty) was 3.9 mm preoperatively and 33.4 mm postoperatively and remained at 30.6 mm after 11.1 months follow-up (8% relapse). One patient in group I (transport distraction osteogenesis) underwent surgical revision because of relapse. Our data showed that for congenital TMJ bony ankylosis both transport distraction osteogenesis and Matthews Device arthroplasty techniques were successful initially; however, the Matthews Device arthroplasty avoided long-term relapse.
Adolescent↗
Chronic expanding hematoma in the temporal region.
We report a rare case of chronic expanding hematoma in the right temporal region that developed into a large mass during 12 years. The patient, who had a history of blunt trauma in her right temporal region at the age of 4 months, noticed a slowly growing mass at the same site in the last few months. Computed tomography revealed a well-circumscribed subcutaneous tumor. The tumor was completely resected. Histopathologically, this tumor was confirmed in the diagnosis of chronic expanding hematoma.
Capillaries↗
Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome.
The prevalence of chronic widespread pain in the general population in Israel was comparable with reports from the USA, UK, and Canada. Comorbidity with fibromyalgia (FM) resulted in somatic hyperalgesia in patients with irritable bowel syndrome. One sixth of the subjects with chronic widespread pain in the general population were also found to have a mental disorder. Mechanisms involved in referred pain, temporal summation, muscle hyperalgesia, and muscle pain at rest were attenuated by the N-methyl-D-aspartate (NMDA) antagonist, ketamine, in FM patients. Delayed corticotropin release, after interleukin-6 administration, in FM was shown to be consistent with a defect in hypothalamic corticotropin-releasing hormone neural function. The basal autonomic state of FM patients was characterized by increased sympathetic and decreased parasympathetic systems tones. The severity of functional impairment as assessed by the Medical Outcome Survey Short Form (SF-36) discriminated between patients with widespread pain alone and FM patients. Chronic fatigue syndrome (CFS) occurred in about 0.42% of a random community-based sample of 28,673 adults in Chicago, Illinois. A significant clinical overlap between CFS and FM was reported. Cytokine dysregulation was not found to be a singular or dominant factor in the pathogenesis of CFS. A favorable outcome of CFS in children was reported; two thirds recovered and resumed normal activities. No major therapeutic trials in FM and CFS were reported over the past year.
Autonomic Nervous System↗
Eyelid reconstruction using temporalis fascia.
A case is reported of traumatic full-thickness loss of half the upper eyelid. The defect was reconstructed using a pedicled temporalis fascial flap in conjunction with a skin graft. The method is useful when more standard forms of reconstruction are impossible. The advantages of using temporalis fascia and some pitfalls are described.
Adolescent↗
Utilization of the superficial temporoparietal fascia in reconstructive plastic surgery. A clinical case.
Reconstruction of the orbit can at times be difficult when tumors of this region are resected. We describe a new surgical procedure to reconstruct the outer canthus of the orbital region, including lateral portions of the upper and lower lids. The techniques that were used until now are often limited in repairing this anatomical area, and the results we obtained with this case encourage us to utilize the superficial temporal fascia.
Carcinoma, Squamous Cell↗
Use of temporalis fascia for exposed hydroxyapatite orbital implants.
The hydroxyapatite implant (Bio-Eye, Intergrated Orbital Implant, Inc., San Diego, CA, U.S.A.) has gained increasing popularity as an orbital implant in recent years. Several complications may occur, including infection, exposure, extrusion, and various peg problems. Exposure of the implant appears to be the most common complication, ranging up to 21.6%. Many techniques, including nonsurgical and surgical approaches, have been described to manage these exposures. When surgery is indicated, a patch graft may be required to cover the defect. We report our experience and technique with autogenous temporalis fascia as a patch graft. Autografts such as temporalis fascia are easily obtained, bring about no immunological reaction, and have no risk of infectious transmission.
Adult↗
Characteristics and response to treatment of posttraumatic temporomandibular disorder: a retrospective study.
Temporomandibular disorders (TMDs) are likely the most common cause of persistent pain in the head and neck. Treatment for TMDs can be quite varied although, in general, favorable treatment outcome is reported to be on the order of 75-80%, regardless of treatment approach. However, it has been reported that patients suffering from posttraumatic TMDs, and, in particular, patients who have been involved in motor vehicle accidents (MVAs), do not respond as well to therapy. Therefore, this study was undertaken to elucidate some of the historical and clinical features of posttraumatic TMDs and to compare this with the features of TMDs that developed independent of identifiable trauma. Furthermore, a comparison between recovery rates in the two populations was undertaken as well as a comparison of the treatment modalities used in the two groups. Fifty-two posttraumatic TMD patients were compared to an age- and sex-matched population of "routine" TMD patients whose conditions developed independent of trauma. Treatment, consisting of various accepted modalities, ranged from 3 to 5 years after the MVA, with progress assessed at each visit. The data indicate that 48% of posttraumatic TMD and 75% of TMD patients reported recovery with treatment (p less than 0.001). The posttraumatic TMD patients required significantly more treatment than the control TMD population. The findings suggest further that 60% of MVA TMD patients suffer from symptoms suggestive of affective disorder compared to only 14% of TMD patients. In view of the above, it appears that posttraumatic TMD patients do not respond to therapy as well as the control subjects. While the mechanisms underlying this finding are not clear, it could be related to a difference in underlying pathophysiology. The data showing that posttraumatic TMD patients develop significantly more symptoms suggestive of affective disorders than control TMD patients could imply that there is a relationship between these findings that requires further study.
Accidents, Traffic↗
The temporalis tendon: CT and MR appearance.
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Cadaver↗
Association of mitochondrial DNA deletions and cochlear pathology: a molecular biologic tool.
The purpose of these experiments was to develop a method of isolation, amplification, and identification of cochlear mitochondrial DNA (mtDNA) from minute quantities of tissue. Additionally, studies were designed to detect mtDNA deletions (mtDNA del) from the cochlea that previously have been amplified from other organ systems and tissues. MtDNA del have been associated with many pathologies, including neurological disorders, sensorineural hearing loss, ischemia, cardiomyopathies, and aging. DNA was extracted from rat and human tissues, and polymerase chain reaction was used to amplify mtDNA sequences. A 360 base pair (bp) cytochrome-b gene product and the highly conserved ND1-16S ribosomal ribonucleic acid regions found only in mtDNA were amplified from all tissues. Preliminary studies have identified a 4834 bp mtDNA del in aged rats and a corresponding 4977 bp mtDNA del in aged humans. Additionally, preliminary results in human archival temporal bone studies reveal the presence of the 4977-bp mtDNA deletion in two out of three patients with presbycusis. The deletion was not evident in age-matched control patients without a history of presbycusis. This technique of mtDNA identification makes it possible to investigate specific mtDNA defects from a single cochlea, promoting the study of hereditary hearing loss and presbycusis at a molecular biologic level.
Aged↗