title: Anatomic basis of the middle temporal artery periosteal rotational flap in otologic surgery.
abstract: To describe the elements critical to successful middle temporal artery periosteal rotational flap harvest and utilization based on the anatomic features of the middle temporal artery.
  
  
  
  Description of anatomy based on cadaver dissection.
  
  
  
  Seventy temporal fossa dissections were performed on 35 adult human cadavers.
  
  
  
  Sixty-nine of 70 dissections had an identifiable middle temporal artery muscular branch pedicle in the periosteum deep to the temporalis muscle. Pedicle length was at least 7 cm in 32 of 38 (84%) male cadavers and in 20 of 31 (65%) female cadavers (P = 0.054), whereas the average length required to reach the digastric ridge from the pedicle base to the digastric ridge in a mastoidectomy cavity was 5.2 cm. The pedicle sharply transitions from a posterior to a posterior-superior course 0.93 cm superior (range: 0.5-1.9 cm) and 0.04 cm posterior (range: 1.4 cm posterior-0.7 cm anterior) to the spine of Henle. Branching occurred in 26 of 69 pedicles (38%), and 20 of 31 (65%) branches were oriented posteriorly. If temporalis muscle fibers are not incorporated into the flap, the thickness is roughly three times that of a standard temporalis fascia graft.
  
  
  
  The muscular branch of the middle temporal artery is reliably identified in the periosteum deep to the posterior aspect of the temporalis muscle, and this vessel is sufficiently robust to provide axial blood supply to a rotational periosteal flap that has sufficient thickness and length to allow a variety of applications in otologic surgery.
  
  
  
  NA. Laryngoscope, 126:1426-1432, 2016.
authors.affiliation: Section of Otolaryngology-Head and Neck Surgery, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Garrick D
authors.initials: GD
authors.lastname: Talmage
authors.affiliation: the Department of Otolaryngology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A.
authors.forename: Jumin
authors.initials: J
authors.lastname: Sunde
authors.affiliation: Section of Otolaryngology-Head and Neck Surgery, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: David D
authors.initials: DD
authors.lastname: Walker
authors.affiliation: Ear Science Institute Australia and University of Western Australia Ear Sciences Centre, Perth, Australia.
authors.forename: Marcus D
authors.initials: MD
authors.lastname: Atlas
authors.affiliation: Section of Otolaryngology-Head and Neck Surgery, University of Chicago Medical Center, Chicago, Illinois.|the Department of Otolaryngology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Gluth
mesh_terms: D000328:Adult; D002102:Cadaver; D004210:Dissection / Q000379:methods; D006801:Humans; D013506:Otologic Surgical Procedures / Q000379:methods*; D010521:Periosteum / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply*; D013699:Temporal Arteries / Q000033:anatomy & histology* / Q000601:surgery; D013703:Temporal Muscle / Q000098:blood supply / Q000601:surgery
keywords: Middle temporal artery; mastoidectomy; rotational flap