Temporalis Muscle Flap for Endoscopic Anterior Skull Base Reconstruction: An Anatomic Study

Background The reconstruction of large anterior skull base defect is one of the major challenges after endoscopic endonasal resection of anterior skull base. The nasoseptal and pericranial flaps have been used to reconstruct the anterior skull base defect, which has significantly decreased the incidence of postoperative cerebrospinal fluid leakage. However, because of the tumor invasion, prior surgery history or radiotherapy, these flaps are not always available.

Objectives We present an anatomic study for the temporalis muscle flap that could be used for the reconstruction of the anterior skull base after endoscopic endonasal resection of it.

Methods Nine fresh injected cadaver heads (18 sides) were prepared for dissection of the temporalis muscle and anterior skull base. The temporalis muscle flap was harvested through an open approach and was transferred to the anterior skull base through ipsilateral maxillary sinus. Using endoscopic transnasal approach created the defect of the anterior skull base.

Result The temporalis muscle flaps can be harvested through an open approach with the pedicle locating on the coronal process of the mandible. The anterior and posterior deep temporal arteries that supply blood to the temporalis muscle can be kept and preserved. The medial and posterior walls of the maxillary sinus were removed to create a transmaxillary corridor. The temporalis muscle flaps were transposed into the nasal cavity through the transmaxillary corridor. The anatomic study showed that the temporalis muscle flaps can reach the anterior skull base and can cover the entire defect of anterior skull base.

Conclusion The temporalis muscle flaps can be transposed into the nasal cavity and can cover the defect of the anterior skull base. The temporalis muscle flap provides an available option for the reconstruction of anterior skull base.