The temporalis: blood supply and innervation

Numerous reports have described the use of the temporalis muscle as a pedicled flap in reconstructive surgery. A detailed knowledge of the supplying vessels and nerves is necessary for functionally successful muscle transposition. However, controversial anatomic descriptions exist. In this study, 60 human cadavers were investigated to identify the arteries and nerves supplying the temporalis. Forty-three cadavers were dissected after embalming with 10% phenol/formaldehyde. An additional 10 cadavers were examined after injecting latex/barium sulfate (ratio, 1:1) to show the parts of the temporalis supplied by each artery using radiography. The innervating motor branches of the trigeminal nerve were identified by the Karnovsky technique in seven fresh cadavers. In all specimens, three arteries supplying the temporalis were identified: the anterior deep temporal artery (anterior part, 30 percent muscle mass), the posterior deep temporal artery (central part, 51 percent muscle mass), and the medial temporal artery (occipital and in 25 percent upper part, 19 percent muscle mass). Motor branches of the trigeminal nerve innervated the temporalis: the deep temporal nerves of the mandibular nerve (98 percent, central part), branches of the buccal nerve (95 percent, anterior part), and branches of the masseteric nerve (69 percent, posterior part). A remarkable variation of innervating nerve branches, and in 12 percent peripheral anastomoses between the motor nerve branches, were observed. The various numbers of innervating nerve branches demonstrate the difficulty of creating innervated or selectively denervated pedicled muscle flaps for reinnervation. Nevertheless, at least two different pedicled flaps using the anterior or central part of the temporalis can be selectively used for reconstructive surgery.