• Maxillofacial Plastic and Reconstructive Surgery
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• v.29 no.2
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• pp.167-173
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• 2007

The temporalis fascia graft has been widely used in the correction of nasal deformities. The fascia can be used alone or combined for augmentation rhinoplasty. The fascia graft provides adequate coverage, contour, and bulk on the profile of the nose, as well as an inconspicuous donor site. A depressed radix area can be successfully corrected by the fascia graft. We present two cases of nasal radix augmentation by using temporalis fascia graft. Two male patients presented with the skeletal class III malocclusion and the depressed radix. A planned orthognathic surgery and the temporalis fascia graft to the radix were performed. The malocclusion and the profile of the patients were markedly improved after the operation. Not only the radix but also the nose was improved in its size and length. There was no noticeable resorption or displacement of the radix area at follow-up. The temporalis fascia graft could be an appropriate surgical technique in radix augmentation and nose lengthening.

• Archives of Plastic Surgery
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• v.50 no.1
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• pp.42-48
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• 2023

Background The temporalis muscle flap transfer with fascia lata augmentation (FLA) is a promising method for smile reconstruction after facial palsy. International literature lacks a detailed anatomical analysis of the temporalis muscle (TPM) combined with fascia lata (FL) augmentation. This study aims to describe the muscle's properties and calculate the length of FL needed to perform the temporalis muscle flap transfer with FLA. Methods Twenty nonembalmed male (m) and female (f) hemifacial cadavers were dissected to investigate the temporalis muscle's anatomy. Results The calculated minimum length of FL needed is 7.03cm (f) and 5.99cm (m). The length of the harvested tendon is 3.16cm/± 1.32cm (f) and 3.18/± 0.73cm (m). The length of the anterior part of the temporalis muscle (aTPM) is 4.16/± 0.80cm (f) and 5.30/± 0.85cm (m). The length of the posterior part (pTPM) is 5.24/± 1.51cm (f) and 6.62/± 1.03cm (m). The length from the most anterior to the most posterior point (aTPMpTPM) is 8.60/± 0.98cm (f) and 10.18/± 0.79cm (m). The length from the most cranial point to the distal tendon (cTPMdT) is 7.90/± 0.43cm (f) and 9.79/± 1.11cm (m). Conclusions This study gives basic information about the temporalis muscle and its anatomy to support existing and future surgical procedures in their performance. The recommended minimum length of FL to perform a temporalis muscle transfer with FLA is 7.03cm for female and 5.99cm for male, and minimum width of 3 cm. We recommend harvesting some extra centimeters to allow adjusting afterward.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.42
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• pp.2.1-2.6
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• 2020

Background: Facial palsy treatment comprises static and dynamic techniques. Among dynamic techniques, local temporalis transposition represents a reliable solution to achieve facial reanimation. The present study describes a modification of the temporalis tendon transfer using a cryopreserved fascia allograft. Case presentation: Between March 2015 and September 2018, seven patients with facial palsy underwent facial reanimation with temporalis tendon transfer and fascia lata allograft. Patients with long-term palsy were considered, and both physical and social functions were evaluated. The mean follow-up time was 21.5 months. No immediate complications were observed. Patients reported improvement in facial symmetry both in static and dynamic. Improvement was noticed also in articulation, eating, drinking, and saliva control. The Facial Disability Index revealed an improvement both in physical function subscale and in the social/well-being function subscale. Conclusions: This modified orthodromic technique allows to reduce the operative time and the risk of complications connected to the use of autologous tissues. The use of the cryopreserved fascia allografts from cadaveric donors seems to provide promising and long-standing results in the treatment of facial palsy.

• Archives of Plastic Surgery
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• v.40 no.4
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• pp.348-352
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• 2013

Background Temporalis muscle transfer produces prompt surgical results with a one-stage operation in facial palsy patients. The orthodromic method is surgically simple, and the vector of muscle action is similar to the temporalis muscle action direction. This article describes transferring temporalis muscle insertion to reconstruct incomplete facial nerve palsy patients. Methods Between August 2009 and November 2011, 6 unilateral incomplete facial nerve palsy patients underwent surgery for orthodromic temporalis muscle transfer. A preauricular incision was performed to expose the mandibular coronoid process. Using a saw, the coronoid process was transected. Three strips of the fascia lata were anchored to the muscle of the nasolabial fold through subcutaneous tunneling. The tension of the strips was adjusted by observing the shape of the nasolabial fold. When optimal tension was achieved, the temporalis muscle was sutured to the strips. The surgical results were assessed by comparing pre- and postoperative photographs. Three independent observers evaluated the photographs. Results The symmetry of the mouth corner was improved in the resting state, and movement of the oral commissure was enhanced in facial animation after surgery. Conclusions The orthodromic transfer of temporalis muscle technique can produce prompt results by applying the natural temporalis muscle vector. This technique preserves residual facial nerve function in incomplete facial nerve palsy patients and produces satisfying cosmetic outcomes without malar muscle bulging, which often occurs in the turn-over technique.

• Anatomy and Cell Biology
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• v.57 no.2
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• pp.288-293
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• 2024

The temporal fascia is a double lamina sandwiching a thick fat layer above the zygomatic bony arch. To characterize each lamina, their developmental processes were examined in fetuses. We observed histological sections from 22 half-heads of 10 mid-term fetuses at 14-18 weeks (crown-rump length, 95-150 mm) and 12 near-term fetuses at 26-40 weeks (crown-rump length, 215-334 mm). The superficial lamina of the temporal fascia was not evident at mid-term. Instead, a loose subcutaneous tissue was attached to the thin, deep lamina of the temporal fascia covering the temporalis muscle. At near-term, the deep lamina became thick, while the superficial lamina appeared and exhibited several variations: i) a mono-layered thick membrane (5 specimens); ii) a multi-layered membranous structure (6) and; iii) a cluster of independent thick fasciae each of which were separated by fatty tissues (1). In the second and third patterns, fatty tissue between the two laminae was likely to contain longitudinal fibrous bands in parallel with the deep lamina. Varying proportions of the multi-layered superficial lamina were not attached to the zygomatic arch, but extended below the bony arch. Whether or not lobulation or septation of fatty tissues was evident was not dependent on age. The deep lamina seemed to develop from the temporalis muscle depending on the muscle contraction. In contrast, the superficial lamina developed from subcutaneous collagenous bundles continuous to the cheek. Therein, a difference in development was clearly seen between two categories of the fasciae.

• Archives of Plastic Surgery
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• v.34 no.3
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• pp.325-329
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• 2007

Purpose: Mobius syndrome is a rare congenital disorder characterized by facial diplegia and bilateral abducens palsy, which occasionally combines with other cranial nerve dysfunction. The inability to show happiness, sadness or anger by facial expression frequently results in social dysfunction. The classic concept of cross facial nerve grafting and free muscle transplantation, which is standard in unilateral developmental facial palsy, cannot be used in these patients without special consideration. Our experience in the treatment of three patients with this syndrome using transfer of muscles innervated by trigeminal nerve showed rewarding results. Methods: We used bilateral temporalis muscle elevated from the bony temporal fossa. Muscles and their attached fascia were folded down over the anterior surface of the zygomatic arch. The divided strips from the attached fascia were passed subcutaneously and anchored to the medial canthus and the nasolabial crease for smiling and competence of mouth and eyelids. For the recent 13 years the authors applied this method in 3 Mobius syndrome cases- 45 year-old man and 13 year-old boy, 8 year-old girl. Results: One month after the surgery the patients had good support and already showed voluntary movement at the corner of their mouth. They showed full closure of both eyelids. There was no scleral showing during eyelid closure. Also full closure of the mouth was achieved. After six months, the reconstructed movements of face were maintained. Conclusion: Temporalis muscle transfer for Mobius syndrome is an excellent method for bilateral reconstruction at one stage, is easy to perform, and has a wide range of reconstruction and reproducibility.

• Archives of Plastic Surgery
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• v.35 no.1
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• pp.86-91
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• 2008

Purpose: The performance of rhinoplasty on the patient who has already undergone unsatisfactory results or complications after augmentation rhinoplasty is a challenging surgical problem. Because the dead space is remained after removal of the foreign body and the thickness of the skin is not even, the deformity would be more conspicuous if the nose is reconstructed again with hard implant only or autogenous cartilage. In these cases, the autogenous fascia can be used to get a good result. We present our clinical experience of secondary rhinoplasty using Scarpa's fascia of lower abdomen. Methods: Thirty-two patients underwent the procedure from March of 2002 to February of 2007. Nine patients were reconstructed with Scarpa's fascia only, eighteen patients were reconstructed with silicone implant and fascia, and five patients were reconstructed with cartilage and fascia for secondary rhinoplasty. Results: There were no major complications. Most of the patients were satisfied with the results. The deviation of the silicone implant and postoperative hypertrophic scar of the donor site were seen in one case each. Postoperative absorption of fascia were seen in two cases using Scarpa's fascia only. Conclusion: Secondary rhinoplasty using Scarpa's fascia is very useful method which offers a minimized donor site scar, low complication rate, shorter operation time and patient satisfaction and prevents the alopecia caused by the harvest of temporalis fascia.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.1
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• pp.1-11
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• 1994

The functional deformity following removal of the maxilla is considerable, especially following maxilla cancer excision. Rehabilitation of oral and maxillofacial region used to be very difficult with prosthesis or traditional flaps. Temporal muscle and fascia flaps have been described for immediate reconstruction following hemi-maxillectomy, but not total maxillectomy. The muscle and superficial fascia of the temporal area differ in their physical characteristics, vascular supply and clinical applications. Both can be employed independently or simultaneously as regional flaps in the reconstruction of a variety of complex craniofacial defects. Four case is presented in which 3 case maxilla cancer, one case non-union after maxilla fracture, and all case showed successful use of this flap. Only one patient developed partial necrosis of the flap ; significant necrosis did not occur in any other patient. This present paper reviews the anatomy, surgical technique and utilisation of temporal muscle and fascia flaps.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.12 no.2
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• pp.55-61
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• 1990

Patients with facial paralysis, in whom nerve damage is irreparable or in whom the innervation of the paralyzed musculature cannot be restored by nerve suture, grafting, or cross-face nerve transplantation, should be offered some form of reconstructive static and dynamic aid. Temporalis muscle-fascia unit used as a circumorbital sling and motor unit is a dynamic controlled reconstructive procedure, but it has several disadvantages such as wide surgical exposure, bulky-looking at lateral canthal area, insufficient voluntary control. This is a case report of facial palsy of posttraumatic lagophthalmos of 41-year-old male, which was corrected by temporalis muscle-tendon transfer with plantaris tendon transplantation.

• Archives of Craniofacial Surgery
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• v.23 no.6
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• pp.274-277
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• 2022

Fractures of the zygoma are rarely encountered in pediatric patients. This report presents a case of a 3-year-old child who presented with a vertically split fracture of the marginal tubercle of the zygoma. The marginal tubercle, a bony portion present on the posterior border of the frontal process, assists in attaching the temporalis fascia. This patient was treated surgically with bony fixation using tissue glue. To the best of our knowledge, no cases of fracture of the marginal tubercle of the zygoma have been reported in the literature. Fractures of the marginal tubercle of the zygoma in pediatric patients may be overlooked because of their anatomic location and the musculoskeletal characteristics of these patients. Here, we discuss the clinical features of marginal tubercle fractures of the zygoma.