Debunking a Surgical Myth: Do Not Touch the Temporalis

Area of Science:

• Plastic Surgery
• Craniofacial Surgery
• Pediatric Surgery

Background:

• A common surgical belief advises against temporalis muscle manipulation due to concerns of atrophy and temporal hollowing.
• This study challenges this long-standing surgical dogma.
• The authors hypothesize that employing standard muscle flap techniques will yield favorable results.

Purpose of the Study:

• To evaluate the safety and efficacy of surgical temporalis muscle manipulation in pediatric craniosynostosis.
• To determine the rates of muscle atrophy, temporal hollowing, and reoperation following temporalis muscle elevation.
• To challenge the conventional surgical wisdom regarding temporalis muscle handling.

Main Methods:

• Retrospective review of patients undergoing calvarial vault remodeling for craniosynostosis (1988-2011).
• Inclusion criteria: nonsyndromic, single-suture synostosis, and at least 5 years of follow-up.
• Outcomes assessed: reoperation rates, recurrent temporal hollowing, and persistent temporalis overcorrection.

Main Results:

• 196 patients met inclusion criteria; 5.1% experienced recurrent bitemporal constriction.
• Overall reoperation rate was 1.5%, with 0.5% for revision flaps and 1.0% for soft tissue augmentation.
• Persistent temporalis overcorrection occurred in 5.6%, with 1.5% requiring intervention for this specific issue.

Conclusions:

• Low reoperation rates for deformity and manageable overcorrection rates challenge the notion of inevitable temporalis muscle atrophy.
• Surgical manipulation of the temporalis muscle is viable when adhering to established plastic surgery principles.
• This study provides evidence to dispel the surgical myth surrounding temporalis muscle handling in craniofacial reconstruction.