Defecto oncológico maxilar reconstruido mediante colgajo de músculo temporal / Maxillary oncologic defect reconstructed with temporal muscle flap / Defeito oncológico maxilar reconstruído por aba muscular temporal

El macizo facial es una región anatómica compleja que alberga órganos sensoriales. El desarrollo de una enfermedad oncológica, así como su tratamiento, causan defectos funcionales y estéticos con un alto costo físico y psíquico para el paciente y su entorno. Es por ello que la reconstrucción representa un reto. Las diferentes posibilidades incluyen prótesis obturatríces, colgajos libres, pediculados o microvascularizados. En este artículo se describirá el colgajo de músculo temporal y se desarrolla un caso clínico de cirugía oncológica maxilar reconstruido mediante éste en un paciente que presenta una lesión exofítica en cuadrante superior derecho, que se extiende sobre el flanco vestibular, reborde alveolar y zona palatina, desde zona de premolares hasta la zona del segundo molar inclusive, impidiéndole usar la prótesis dental. Esta cirugía es una técnica económica, que requiere menor tiempo quirúrgico que otras técnicas, asociándose a poco porcentaje de fracaso y pocas complicaciones post operatorias.

The facial mass is a complex anatomical region that houses sensory organs. The development of an oncologic disease, as well as its treatment, causes functional and esthetic defects with a high physical and psychological cost for the patient and his environment. This is why reconstruction represents a challenge. The different possibilities include obturator-root prostheses, free, pedicled or microvascularized flaps. In this article the temporal muscle flap will be described and a clinical case of maxillary oncologic surgery reconstructed by means of it is developed in a patient who presents an exophytic lesion in the right upper quadrant, which extends over the vestibular flank, alveolar ridge and palatal area, from the premolar area up to and including the second molar area, preventing him from using the dental prosthesis. This surgery is an economical technique that requires less surgical time than other techniques, and is ass

A massa facial é uma região anatômica complexa que abriga órgãos sensoriais. O desenvolvimento de uma doença oncológica, assim como seu tratamento, causa defeitos funcionais e estéticos com alto custo físico e psicológico para o paciente e seu ambiente. A reconstrução é, portanto, um desafio. As diferentes possibilidades incluem as próteses de raiz obturadora, abas livres, pediculadas ou microvascularizadas. Este artigo descreve o retalho muscular temporal e descreve um caso clínico de cirurgia oncológica maxilar reconstruída utilizando-o em um paciente com lesão exofítica no quadrante superior direito, estendendo-se pelo flanco vestibular, rebordo alveolar e área palatina, desde a área do pré-molar até a área do segundo molar inclusive, impedindo-o de utilizar a prótese dentária. Esta cirurgia é uma técnica econômica, que requer menos tempo cirúrgico que outras.

Distribución nerviosa interna del músculo temporal humano: consideraciones anatómicas y quirúrgicas / Internal nervous distribution of the human temporal muscle: anatomical and surgical considerations

Resumen Introducción: Conocer en detalle la inervación interna del músculo temporal humano permite realizar múltiples técnicas quirúrgicas y tratamientos de patologías que involucran al territorio craneofacial. Si bien en la literatura se ha descrito la inervación interna del músculo temporal humano basado en micro-disección directa, la técnica de tinción de Sihler es una herramienta ventajosa para el estudio anatómico ya que permite observar ramos nerviosos pequeños sin perder su relación tridimensional con las fibras musculares. Objetivo: Describir la distribución nerviosa al interior del músculo temporal humano en cadáveres al aplicar el método de Sihler y analizar su asociación anátomo quirúrgica. Materiales y Método: Ocho músculos temporales humanos previamente disecados fueron sometidos al método de tinción de Sihler. Cada una de las muestras se observó bajo lupa estereoscópica y transiluminación; finalmente para su descripción se dividió al músculo en tres regiones. Resultados: Se determinó la presencia de tres troncos nerviosos principales: el temporal profundo anterior, el temporal profundo medio y temporal profundo posterior, los que discurren de profundo a superficial. Además, se observaron ramos colaterales de menor calibre del nervio temporal profundo posterior que en forma de arco comunican las tres regiones del músculo. Conclusión: Se describió una distribución nerviosa interna común para los músculos estudiados en las tres dimensiones del espacio, conocimiento útil para innovar en terapias clínico-quirúrgicas del territorio craneofacial.

Introduction: Knowing in detail the inner innervation of the human temporal muscle allows to perform multiple surgical techniques and treatments of pathologies that involve the craniofacial territory. Although the internal innervation of the human temporal muscle based on direct microdissection has been described in the literature, the Sihler staining technique is an advantageous tool for anatomical study since it allows observing small nerve branches without losing its three-dimensional relationship with muscle fibers. Aim: To describe the nervous distribution within the human temporal muscle in cadavers by applying the Sihler method and analyzing its surgical anatomical association. Materials and Method: Eight previously dissected human temporal muscles were subjected to the Sihler staining method. Each one of the samples was observed under stereoscopic magnification and transillumination, finally for its description the muscle was divided into three regions. Results: The presence of three main nervous trunks was determined: the anterior deep temporal, the deep medium temporal and the posterior deep temporal, those that run from deep to superficial. In addition, collateral branches of lesser caliber of the posterior deep temporal nerve that in the form of an arc communicate the three regions of the muscle were observed. Conclusion: A common internal nervous distribution was described for the muscles studied in the three dimensions of space, useful knowledge to innovate in clinical-surgical therapies of the craniofacial territory.

Suspensão temporofrontal gálea-periostal com duplo acesso: tática conservadora / Temporofrontal galea periosteal lifting with double access: a conservative procedure

INTRODUÇÃO: O tratamento do terço superior da face deve ser amplo, englobando as regiões frontal e temporal. Entretanto, em decorrência das potenciais complicações e da cicatriz extensa, o lifting coronal tem sido evitado e substituído por técnica endoscópica e procedimentos menos invasivos, porém, talvez, menos eficazes. O objetivo deste estudo é propor uma tática cirúrgica com eficácia similar à do lifting coronal, sem, no entanto, as complicações típicas desse procedimento. MÉTODO: Foi realizada análise retrospectiva de 20 pacientes do sexo feminino, consecutivas, com média de idade de 53,3 anos, submetidas a lifting cervicofacial, no período de fevereiro de 2008 a julho de 2011. Foram avaliadas a sensibilidade da região abordada (anestesia, hipoestesia, hiperestesia, parestesia), a função motora do ramo temporal do nervo facial (movimento do músculo frontal), e a cicatrização (alargamento e alopecias). RESULTADOS: Não houve complicações sensitivas ou motoras, bem como vasculares. Também não foram observados alargamento cicatricial ou alopecias. Uma paciente precisou de revisão da miectomia dos músculos corrugadores e outra foi submetida a miectomia do músculo orbicular lateral do olho, para otimização do resultado. CONCLUSÕES: A tática é segura, simples, não necessita de equipamentos ou materiais especiais, e tem a vantagem da ampla e boa distribuição cutânea, englobando as regiões frontal e temporal.

BACKGROUND: Surgical treatment of the superior third of the face should usually involve an extensive area, including the frontal and temporal regions. However, the open coronal technique has been avoided because it carries a risk of potential complications and a wide scar. The technique has been supplanted by endoscopic and other less-invasive techniques, which are perhaps less efficacious. This article proposes an open technique that maintains the coronal lifting efficiency without its typical complications. METHODS: A retrospective analysis of 20 consecutive female patients who underwent cervicofacial facelift from February 2008 to July 2011 was performed. The patients had a mean age of 53.3 years (range, 46-71 years). The sensitivity of the regions covered (i.e., anesthesia, hypoesthesia, hyperesthesia, paresthesia), motor function of the temporal branch of the facial nerve (i.e., frontal muscle movement), and healing (i.e., widening and alopecia) were evaluated. RESULTS: There were no sensory, motor, or vascular complications. Moreover, neither cicatricial enlargement nor alopecia was observed. One patient required revision of the corrugator muscle myectomy, and another underwent myectomy of the lateral orbicularis muscle of the eye for optimal results. CONCLUSIONS: The proposed technique is simple, safe, does not require special equipment or devices, and has the advantage of wide and harmonious distribution of the flap, including the temporal and frontal regions.

Effects of temporal muscle detachment and coronoidotomy on facial growth in young rats

This study analyzed the effects of unilateral detachment of the temporal muscle and coronoidotomy on facial growth in young rats. Thirty one-month-old Wistar rats were distributed into three groups: detachment, coronoidotomy and sham-operated. Under general anesthesia, unilateral detachment of the temporal muscle was performed for the detachment group, unilateral coronoidotomy was performed for the coronoidotomy group, and only surgical access was performed for the sham-operated group. The animals were sacrificed at three months of age. Their soft tissues were removed, and the mandible was disarticulated. Radiographic projections-axial views of the skulls and lateral views of hemimandibles-were taken. Cephalometric evaluations were performed, and the values obtained were submitted to statistical analyses. There was a significant homolateral difference in the length of the premaxilla, height of the mandibular ramus and body, and the length of the mandible in all three groups. However, comparisons among the groups revealed no significant differences between the detachment and coronoidotomy groups for most measurements. It was concluded that both experimental detachment of the temporal muscle and coronoidotomy during the growth period in rats induced asymmetry of the mandible and affected the premaxilla.

Preservation of palatal mucoperiosteum for oronasal separation after total maxillectomy.

Background: Oronasal communication occurs after total maxillectomy for advanced sinonasal cancers. This results in feeding, breathing and cosmetic impairment. Various methods have been described to close off the palatal defect from the oral cavity to improve the function of speech and deglutition. Aims: The object of this article is to describe our experience of preservation of palatal mucoperiosteum for oronasal separation. Materials and Methods: Retrospective review of clinical and operative records of 31 total maxillectomy patients where oronasal separation was achieved by the conventional technique of applying a maxillary obturator. The postoperative complications arising from the use of maxillary obturator for oronasal communication after total maxillectomy in these 31 patients were analysed. To avoid the complications encountered in these 31 patients we preserved and used the ipsilateral palatal mucoperiosteum for oronasal separation. This new technique was applied in 12 patients. The results are presented and compared. Results : A total of 43 patients underwent total maxillectomy for advanced sinonasal tumors. In 31 patients the conventional maxillary obturator was used for oronasal separation. Among these patients, 30 had crustation of the maxillary cavity, nasal regurgitation and cheek skin retraction in 15 each, trismus in eight, infection of skin graft donor site in seven, cheek movement during respiration in five and ill-fitting prosthesis in three. In 12 patients palatal mucoperiosteum was preserved and used for oronasal separation. The complications encountered in oronasal separation by palatal prosthesis were avoided in the modified procedure. Conclusions: We found that oronasal separation by preservation of palatal mucoperiosteum following total maxillectomy allowed excellent palatal function, prompt rehabilitation and minimal complications without compromising the prognosis.

[Efficacy of temporal myoplasty in correcting the facial deformity of patients suffering from hemi-facial palsy]

Facial nerve palsy can occur due to several causes and accordingly, several treatments have been proposed by plastic surgeons. This study is to determine the efficacy of temporal myoplasty in correcting the facial deformity of patients suffering from hemi-facial palsy whom were referred to "15 Khordad" hospital between 1381- 1385. Participants were 6 patients with hemi-facial palsy who referred continuously and were neither candidated for microscopic surgery, nor can tolerate free muscle transposition surgery. We conducted a clinical case study to compare pre and post-operation stages. In these patients, the new one-stage method of temporal tendon transposition to lip's commissure [without any grafting] was performed. They were followed for an average of 2 years. Assessments were made in terms of their age, sex, facial palsy cause, palsy duration, complications, and lip's commissure range of motion. Pre and post-operation photos were taken and physical examination was documented and analyzed for each case. Two cases [out of six ones] were men and the others were women. Their age range was 38.2 +/- 14 years old. In three cases, facial palsy was a post-traumatic result. One patient had congenital form. In another one it was due to tumor resection complications. The last patient was a tympanoplasty case. Palsy duration range was 28.7 +/- 11 months. No complication was seen after the operation. In early post-operation stage, 50% of patients had good static facial position and in remained 50% the result was excellent. However, in delayed stages, the percentages for excellent, good and moderate outcomes were 66, 17 and 17, respectively. Despite the well dynamic facial position in early post-operation stages among all the cases, in delayed stages the percentages for excellent, good and moderate results were reduced to 50, 33 and 17, respectively. It seems that for those who can not tolerate long operations nor like to do so, temporal myoplasty might be an acceptable method as an alternative for the standard surgical methods applied for hemi-facial palsy [i.e. the microscopy procedure]. It is recommended to conduct an absolute experimental study in this regard

Management of pediatric temporomand bular joint ankylosis: use of costochondral rib graft with interpositiona, temporalis myofacial flap

The posttraumatic ankylosis of the temporomandibular joint [TMJ] is frequently seen in children in Pakistan. The factors which favour in the development of this condition are; the children exhibit much more liability to emergency management, greater difficulty in clinical and radiological examination, state of mixed dentition, faster rate of healing, non-availability of specialists and low socioeconomic status of the patient. Different autogenous and alloplastic interpositional materials have been attempted after the resection of the ankylotic bone to achieve desirable results. All patients were presented at Punjab Dental and Children Complex Hospitals Lahore. Twenty-three children [age 1 to 15years] with 28 joints underwent costochondral arthroplasty with interpositional temporalis myofacial flap, out of which 6 were of re-ankylosis after surgery at other centres. The costochondral graft was fixed by tripod screws with remaining ramus condylar unit. The surgery was planned after caref ul examination and final radiographic confirmation. The preoperative CT scan was also performed in few patients. The surgical protocol is used to achieve the desirable interincisal jaw opening [>30mm] that was also the postoperative criteria for successful surgery. Five patients with bilateral ankylosis were operated and one patient with additional ipsilateral coronoidectomy. Less than 30mm interincisal opening was considered as unsatisfactory jaw opening. The overall success rate was 96% with only one patient was observed with less than 30mm opening. The lateral and protrusive jaw movements were assessed as excellent, good and poor. The immediate postoperative complications were transient. The ankylosis develops mainly after damage to mandibular condyles or TMJ at a growing age. Results with the procedure were encouraging without noticeable complications during an average follow up of one year

Experience with temporalis muscle transfer for dynamic reanimation of paralyzed face in long-standing cases of facial palsy

Paralysis of facial nerve leads to a severe deformity which seriously handicaps the patients, both aesthetically and functionally. Anderson's modification of Gilles' technique involves the use of ipsilateral temporalis muscle lengthened by the slips of its overlying temporalis fascia to restore function and rehabilitate the patient with typical deformity. A total of 28 patients underwent facial reanimation with this technique at the Department of Plastic Surgery, Mayo Hospital, Lahore from January 1990 to June 1998. The mean age was 23.25 years and mean duration of facial palsy was 14.5 years at the time of presentation. The results were evaluated in terms of aesthetic and functional improvement. The aesthetic appearance of eye was excellent in 3 patients, good in 23 patients. Functional recovery was excellent in 15 patients, good in 12 patients and satisfactory in one patient. Aesthetic improvement in the region of cheek and oral sphincter was excellent in 4 patients, good in 17 patients, satisfactory in 5 patients and poor in 2 patients. Functional gain In this region showed excellent results in 7, good in 15, satisfactory in 5 patients and poor in one patient. The results reaffirm the role of dynamic reanimation, in long standing cases of facial palsy, by temporalis muscle transfer

Preservaçäo do ramo frontotemporal do nervo facial na craniotomia pterional: técnica de Speltzler e Lee: relato de 45 casos / Preservation of the frontotemporal branch of the facial nerve using Spetzler and Lee's technique for pterional craniotomy: report of 45 cases

No período entre dezembro de 1990 e novembro de 1994 (4 anos) 47 aneurismas cerebrais foram tratados através da craniotomia pterional. A técnica de Spetzler e Lee foi utilizada na abertura do músculo temporal, tendo sido observada a preservaçäo, do ramo frontotemporal do nervo facial, em todos os casos. É importante observar que houve boa exposiçäo da crista esfenoidal, reduçao do tempo cirúrgico e bom resultado cosmético com está técnica.

Resultados da correçäo cirúrgica do lagoftalmo (técnica de Gillies) em doentes de hanseníase / Results of surgical correction of lagophthalmos (Gillies technique) in leprosy patients

Foram analisados os resultados de 51 cirurgias de transferência do músculo temporal (Técnica de Gillies), realizadas em 34 pacientes com lagoftalmo. O principal objetivo foi avaliar a extensao e o tempo para recuperaçao da oclusao palpebral voluntária e o efeito estático da técnica sobre a pálpebra inferior, nos casos com ectrópio parcial e epífora. Em 34 (66.67 por cento) olhos houve recuperaçao completa e duradoura da oclusao palpebral voluntária. As medianas dos tempos para obtençao de fendapalpebral zero, ao morder, foram de 8 dias (l - 120) nos casos do grupo excelente e de 14 dias (l - 120) nos casos do grupo bom. A correçao do ectrópio parcial e epífora foi constatada em 15 (83,33 por cento) olhos. A recuperaçao da oclusao palpebral voluntária e a reposiçao da pálpebra inferior, observada na maioria dos casos, confirmam a efetividade da técnica de Gillies para correçao do lagoftalmo.

El colgajo del músculo temporal y su aplicación en la cirugía maxilofacial / The temporal muscle flap and its application in maxillofacial surgery

El músculo temporal, craneomandibular, invervado por el nervio trigémino, posee una gran participación en la dinámica mandibular. Su excelente irrigación lo ha convertido en un colgajo de enorme importancia en la cirugía reconstructiva maxilofacial. Esta propiedad se descubre a fines del siglo pasado con los trabajos de Glovine a nivel de órbita, pero se vuelve relevante en los últimos quince años siendo utilizado, este versátil colgajo, en un amplio rango de defectos como: resección de tumores, cirugía de ATM, restauración del contorno facial e incompetencias velofaríngeas entre otros. Mediante el siguiente trabajo se presenta una detallada y seleccionada revisión biliográfica, sobre una base dada por los textos clásicos, con el aporte de nuevos conceptos establecidos en artículos recientemente publicados. Se describen la anatomía quirúrgica del músculo temporal, las indicaciones para la utilización de su colgajo y la variabilidad de opciones que el mismo presenta, realizándose en cadáveres formolizados la reproducción de las técnicas más sobresalientes adjuntas a su correspondiente descripción

Nueva técnica de mioplastia con utilización de musculo temporal y cartilago / A new myoplasty technique using temporal muscle and cartilage

Se analizaron los resultados obtenidos en operaciones realizadas a 2 cadáveres humanos, 14 animales de experimentación y finalmente a una paciente afectada de hemiatrofia facial progresiva. Se determinó que es posible corregir los defectos faciales, especialmente el Síndrome de Parry Romber, utilizando la técnica quirúrgica de la mioplastia temporal combinada con injerto autógeno de cartílago costal, cubierto con pericondrio

Management of a case of lagophthalmos by Gillies' method (a case report).

A case of facial palsy with lagophthalmos with exposure keratitis was corrected surgically by a method of temporalis transfer. When the slings were tightened leaving 1 cm gap in the palpebral aperture, lagophthalmos persisted. A secondary tightening procedure causing overlap of the upper lid over the lower yielded good results.