title: The inverted temporalis muscle flap for intraoral reconstruction: its rationale and the results of its application.
abstract: OBJECTIVE
  The purpose of this article was to show the discrepancies among the different parts of the temporalis muscle flap (TMF), to introduce a new rotational arc for the TMF based on these findings, and to examine the outcomes associated with the use of this modified method.
  
  
  METHODS
  Two models were established on 5 human skulls to mimic the situations with the usual dissection technique or the extended dissection technique for the TMF. The lengths of the anterior part, the middle part, and the posterior part of the flap were measured and analyzed for statistical significance. A new rotational arc for the TMF was introduced, in which the flap was inverted beneath the zygomatic arch, placing the temporalis fascia away from the oral side. Seventeen consecutive oral cancer cases treated with either the traditional method or the inverted method of flap transposition were reviewed and divided into 2 groups dictated by the rotational arcs of their flaps. The traditional TMF was used in 11 cases and the inverted TMF was used in 6 cases. Clinical examination and imaging studies were used for assessment of outcome, and the results from the 2 patient groups were compared.
  
  
  RESULTS
  The middle and posterior parts of the temporalis muscle were significantly longer than the anterior part on the skull models. However, the middle and posterior parts did not differ greatly in length. The extended dissection technique increased the flap length except for the anterior part. Both flaps were successful in closing the defects in all cases and healed well. No muscle necrosis was observed. However, the patients receiving the traditional TMF developed noticeable cheek fullness in 4 instances, sialocele in 3, significant reduction of range of mouth opening in 2, and distinct velopharyngeal insufficiency in 2, whereas only 1 case in which the inverted TMF was used developed cheek fullness.
  
  
  CONCLUSIONS
  The middle or posterior part of the temporalis flap is preferred over the anterior part for covering distant defects because of its extra length. The inverted TMF is simple and safe to apply. It can extend farther in the posterior oral cavity and has fewer complications than the traditional TMF.
authors.affiliation: Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Cheng Kung University Medical Center, Tainan, Taiwan, ROC. wongty@mail.ncku.edu.t
authors.forename: Tung-Yiu
authors.initials: TY
authors.lastname: Wong
authors.forename: Ching-Hung
authors.initials: CH
authors.lastname: Chung
authors.forename: Jehn-Shyun
authors.initials: JS
authors.lastname: Huang
authors.forename: Hung-An
authors.initials: HA
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D003528:Carcinoma, Adenoid Cystic / Q000534:rehabilitation / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000534:rehabilitation / Q000601:surgery*; D002508:Cephalometry; D005260:Female; D005881:Gingiva / Q000601:surgery; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery; D008441:Maxillary Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D008875:Middle Aged; D008953:Models, Anatomic; D009061:Mouth Mucosa / Q000601:surgery; D009062:Mouth Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D019647:Oral Surgical Procedures / Q000379:methods*; D010160:Palate, Soft / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D013703:Temporal Muscle / Q000637:transplantation*; D016896:Treatment Outcome