The temporalis muscle flap for intraoral reconstruction.

In this series of seven patients, we used the temporalis muscle flap for reconstruction of tongue and floor-of-mouth defects. For intraoral reconstruction, the temporalis muscle flap has advantages over the standard workhorse flap, the pectoralis major. The temporalis muscle flap is far less bulky, more pliable, non-hair bearing, and in closer proximity to the oral cavity. Use of this muscle does not impair mandibular function. The depression that results after the temporalis muscle has been transferred is minimal. Most of this donor area is covered by hair. The only site where the depression can be significant is at the zygomatic arch, where the tunnel into the mouth is formed after removal of the arch. If the arch is wired back into position, this aesthetic detriment is obviated. In gaining exposure of the zygomatic arch, significant traction can be placed on the soft tissues through which the temporal branch of the facial nerve runs. In one patient, a temporal nerve branch paralysis occurred that required a browpexy; in another patient, there was a transient paresis; and in the others, there was no deficit. The temporalis muscle flap is hardy and durable, and has become our mainstay flap for intraoral reconstruction.