Harriet Jones, Nikhil Desai, Yasser Safdar, Muzzammil A Nusrath

The temporalis muscle flap is a versatile flap that can be used reliably for orbital, palate, cheek and ear reconstructions. It is popular due to its ease of harvest and minimal morbidity. The blood supply is mainly from the deep temporal artery which enters deep to the zygomatic arch on its medial side and the fascia is supplied via the superficial temporal artery. We retain the fascia on the temporalis muscle to use it as a guide in orientation when reconstructing maxillectomy defects. The fascia has to be oriented towards the oral cavity and should be visible. To avoid twisting and to facilitate transfer into the Oral cavity underneath the zygomatic arch we place four sutures; the medial suture is kept longer than the lateral one, the long suture side is oriented to close towards the soft palate side, and the shorter suture towards the maxillary alveolus. The fascia can be removed once the orientation is carried out or if the superficial temporal artery is injured. Utilising the fascia and the sutures we are able to correctly orientate the muscle without jeopardising the blood supply. Temporalis flaps can easily fail if they are twisted or turned the same way strangulating the blood supply. We aim to discuss this technique in detail along with demonstrating it in a number of treatment cases.

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