Augmentation of temporal fossa hollowing with Mersilene mesh

Temporal fossa hollowing can represent a serious cosmetic concern to patients', whether congenital; part of a post-traumatic deformity; following oncological resection; or following orbital decompression procedures. Various methods have been described to augment the defect including high density polyethylene (HDPE) implants, methyl methylmethacrolate and lipotransfer, but all have their relative drawbacks.

We describe 13 temporal defects in 10 patients whose defects have been reconstructed with Mersilene mesh (Ethicon, Livingstone UK). When the temporalis muscle is still adequately suspended; folded mesh can be placed in a submuscular/subperiosteal plane. The mesh can be folded as many times as necessary to recreate the appropriate volume, thereby allowing fine control of temple width. If the temporalis is attenuated or displaced inferiorly by previous surgery, its insertion can be recreated using titanium screws to attach the mesh superiorly to the appropriate site on the cranium; the temporalis resuspended and the fascia sutured to the mesh.

We report very pleasing cosmetic results with no associated complications such as implant, extrusion or exposure. One patient was complicated by infection requiring removal of the mesh as well as titanium cranioplasty, screws and plates.

Mersilene mesh is easy to use, contours naturally to the defect and is considerably cheaper than alternatives like HDPE implants.