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Dissection of temporalis muscle
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Transcranial frontotemporal orbitozygomatic approach for resection of adult craniopharyngiomas
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This video segment provide a detailed description of the optimal incison for the FTOZ approach and scalp flap elevation technique.
Keywords
- skin incision
- Temporalis fascia
- facial nerve
- superficail temporal artery
About this video
- Author(s)
- Victoria Dembour
- Giulia Cossu
- Lorenzo Giammattei
- Roy Thomas Daniel
- Mahmoud Messerer
- First online
- 10 November 2022
- DOI
- https://doi.org/10.1007/978-3-031-21023-5_5
- Online ISBN
- 978-3-031-21023-5
- Publisher
- Springer, Cham
- Copyright information
- © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022
Video Transcript
This figure shows the multiyear disposition of the skull in the temporal area. The first layer is the skin, then subcutaneous fat. The superficial temporal fascia, which is continuous with the galea superiorly. And then the superficial and deep layer of the deep temporal fascia with the deep temporal fat pad in between.
And lastly, temporalis muscle, the pericranium and the bone. We represented the course of the superficial temporal artery within the thickness of the superficial temporal fascia and the frontal branches of the facial nerves in the subcellular fat pad between the superficial and deep temporal fascia.
Skin incision is performed through the galea to the level of the cranium and the superficial temporal fascia. Below the superior temporalis line, subcutaneous tissue and superficial temporal fascia are gently dissected with scissors. And superficial temporal artery is preserved.
To avoid injury to the facial nerve, the incision does not extend more than one centimeter below zygoma. Then the subfascial dissection technique is used to preserve the frontalis branches of the facial nerve. The deep temporal fascia is incised inferiorly perpendicular to the superior temporal line and the incision is continued superiorly one centimeter below and parallel to the superior temporal line living a narrow myofascial cuff superiorly for later re-approximation. Both facial layers with a the pad are elevated together anteriorly. The skin flap is reflected to the upper part of the orbital rim at the level of the supraorbital foramen.