Anatomic Study And Clinical Application Of Mandibular Bone Flap Pedicled With Temporal Muscle To Repair Maxillary Bone Defects

Objective: The shape and blood supplies of the temporal muscle and mandibularramus relation were observed by anatomy of dependency structure of mandible andtemporal muscle. The relevant data was measured. To provide anatomical basis forthe mandibular bone flap pedicled with temporal muscle to repair maxillary bonedefects. The study is to evaluate the clinical effect of the mandibular bone flappedicled with temporal muscle to repair maxillary bone defects and to prove that themandibular bone flap pedicled with temporal muscle is an ideal method of repairingthe maxillary bone defect by reviewing clinical cases of mandibular bone flappedicled with temporal muscle for alveolar process of maxilla or orbital floorreconstruction of the maxillectomy defects.Methods:1. Anatomical study:①30sides of dry mandible were selected by random,age and sexcouldn’t be exactly judged.All mandibles were normal, without bone resorption.Mandibular bone section were made according to position of mandibular canal. Theshape of mandible were observed and the relevant data was measured.②15cadaversof adults(9cadaver of man,6cadaver of woman) fixed by10%formalin, The cadaverswere injected by red ratex through common carotid artery. The lateral surface of headspecimens was dissected one by one after24hours. The shape and blood supplies andadjacent of the temporal muscle and mandibular ramus and the relavant relationwere observed, the relevant data was measured. The result was carried on withSPSS13.0statistics software to analyze the obtained results, data was expressed bymeans of x±s.2. Part one of clinical application: Clinical application of mandibular bone flap pedicled with temporal muscle to repair processus alveolaris maxillae defects, frommarch2008to November2010, partial maxillectomy were performed in4patientswith maxillary gingival malignant tumor, in3patients with maxillary bone malignanttumor, in1patients with pars palatalis malignant tumor. The patients age ranged from16to68years, mean age were60.13years. five of them were male and the other threewere female. Classification of all maxillectomy were BrownⅡb defects, maxillaryalveolar process defects of maxillectomy were reconstructed with mandibular boneflap pedicled with temporal muscle, hard palate defects were repaired by palate flapor antebrachial flap. The effect was estimated by follow up.3. Part two of clinical application: Clinical application of mandibular bone flappedicled with temporal muscle to repair orbital floor defects, from December2009toDecember2010, total or to enlarge maxillectomy were performed in4patients withmaxillary bone malignant tumor. The patients age ranged from44to66years, meanage were59.25years. Three of them were male and one were female. Classificationof all maxillectomy were type BrownIIIb defects of2pations and type BrownIIIddefects of2pations, orbital floor defects of maxillectomy were reconstructed withmandibular bone flap pedicled with temporal muscle, hard palate defects of2pationswere repaired by antebrachial flap. The effect was estimated by follow up.Results:1. Anatomical study: The temporal muscle has fan-shaped main portion, then isscattered three bundles as anterolateral, anteromedial, posterior bundes, which endrespectively at anterior border of ramus, the temporal ridge and posterior portion ofcoronoid process, Then the muscler goes downwared until it reaches the distal side ofthe third medial surface molar and attaches the of3/4of medial surface of anteriorportion of ramus. The blood supply of temporal muscle includes the medial temporalartery with external diameter of ((0.76±0.20)mm, the anterior deep temporal arterieswith external diameter of (0.79±0.21) mm, posterior deep temporal arteries withexternal diameter of (0.98±0.64) mm, the accessory deep temporal artery formed bymany little branches. The anterior part of ramus is supplied by the periosteal arteriesand the bony perforator of the deep temporal arteries. Rectangular ramus of mandible was divided into anterior portion and posterior portion by the line linking the lowestpoint of mandibular notch,mandibular foramen to mandibular canal. Anterior portioncan supply a bone flap with size of (46.67±6.85)mm×(17.98±2.64)mm×(11.49±0.99)mm.2. Part one of clinical application: Primary reconstruction of the processus alveolarismaxillae defects was carried out using mandibular bone flap pedicled with temporalmuscle. All the bone flaps were alive.The patients were followed up for3to36months, with an average of22months,2pations can eat common food by fixedartifical teeth,all pations acquired satisfactory appearance of maxillary alveolarprocess and dental arch. The appearance and function were reconstructed successfully.There were no donor site problems.3. Part two of clinical application: Primary reconstruction of the orbital floor defectswas carried out using mandibular bone flap pedicled with temporal muscle.All thebone flaps were alive. With a follow-up period from3to12months,with an averageof8.25months, we obtained significant improvement of functional and aestheticallyacceptable results without global ptosis, enophthalmos, diplopia, ectropion. Therewere no donor site problems.Conclusion:1. The mandibular bone flap pedicled with temporal muscle has a reliable bloodsupply and abundant bone volume, It is feasible to design mandibular bone flappedicled with temporal muscle for maxillary bone defects.2. The mandibular flap pedicled with temporal muscle is easy to elevate, quick, safe,obtain satisfactory appearance and fountion, low complication of donor site. It is anideal method of repairing the the processus alveolaris maxillae defects or the orbitalfloor defects.