The temporalis muscle flap for reconstruction after head and neck oncologic surgery

Objective. To explain the applications, technique, and potential complicati ons of the temporalis muscle flap used for immediate or delayed reconstruct ion of head and neck oncologic defects. Study Design: Fresh cadaver dissect ion and 5-year retrospective chart review. Methods: A fresh cadaver dissect ion was performed to illustrate the surgical anatomy of the temporalis musc le flap with attention to specific techniques useful in avoiding donor site morbidity (facial nerve injury and temporal hollowing). A chart review was performed for 13 consecutive patients from. the last 5 years who underwent temporalis muscle flap reconstruction after oncologic resection of the lat eral and posterior pharyngeal wall, hard and soft palate, buccal space, ret romolar trigone, and skull base. Results: Patient follow-up ranged from 2 t o 45 months. Nine patients had radiation therapy. There were no cases of fl ap loss. Resection of the zygomatic arch followed by wire fixation facilita tes flap rotation and minimizes trauma to the flap during placement into th e oropharynx. Preservation of the temporal fat pad attachment to the scalp flap decreases temporal hollowing and protects the facial nerve. Replacing the zygoma and preserving the anterior third of the temporalis muscle in si tu further diminishes donor-site hollowing. Conclusions: Compared with othe r regional flaps, such as the pectoralis myocutaneous flap, the temporalis muscle flap is associated with low donor-site esthetic and functional morbi dity and offers great flexibility in reconstruction. The temporalis muscle flap is a useful, reliable flap that belongs in the armamentarium of surgeo ns who are involved with reconstruction of head and neck tissue defects.