Temporalis Muscle Flap for Reconstruction Following Lateral Temporal Bone Resection: Anatomical Study and Technical Note.

There are no standardized guidelines for reconstructive surgery of large temporal bone defects following lateral temporal bone resection for external auditory (acoustic) meatus carcinoma. Filling the defect with well-vascularized tissue is important for large tissue defects to promote wound healing and prevent infection postoperatively. Patients with malignant tumors of the external acoustic meatus requiring lateral temporal bone resection may sometimes necessitate postoperative adjuvant chemoradiotherapy. Therefore, it is essential to facilitate wound healing and initiate adjuvant therapy promptly after surgery. Moreover, to prevent complications such as osteonecrosis after radiotherapy, filling the defect with well-vascularized tissue is particularly important. Reconstructing a large temporal bone defect using the temporalis muscle following lateral temporal bone resection requires several surgical tips based on anatomical knowledge. However, no previous reports have described these techniques in detail. In this report, we highlight that the creation of an effective temporalis muscle flap for large temporal bone defects after lateral temporal bone resection requires cutting the deep layer of the temporalis fascia and the pericranium, as well as the separation of tendinous structures within the temporalis muscle. In this report, based on the microsurgical anatomy of the temporalis muscle, we present an effective method for creating a reliable temporalis muscle flap for reconstructive surgery.