Kadri Paulo A S, Al-Mefty Ossama
Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
J Neurosurg. 2004 Mar;100(3):517-22. doi: 10.3171/jns.2004.100.3.0517.
Mobilizing the temporal muscle is a common neurosurgical maneuver. Unfortunately, the cosmetic and functional complications that arise from postoperative muscular atrophy can be severe. Proper function of the muscle depends on proper innervation, vascularization, muscle tension, and the integrity of muscle fibers. In this study the authors describe the anatomy of the temporal muscle and report technical nuances that can be used to prevent its postoperative atrophy.
This study was designed to determine the susceptibility of the temporal muscle to injury during common surgical dissection. The authors studied the anatomy of the muscle and its vascularization and innervation in seven cadavers. A zygomatic osteotomy was performed followed by downward mobilization of the temporal muscle by using subperiosteal dissection, which preserved the muscle and allowed a study of its arterial and neural components. The temporal muscle is composed of a main portion and three muscle bundles. The muscle is innervated by the deep temporal nerves, which branch from the anterior division of the mandibular nerve. Blood is supplied through a rich anastomotic connection between the deep temporal arteries (anterior and posterior) on the medial side and the middle temporal artery (a branch of the superficial temporal artery [STA]) on the lateral side.
Based on these anatomical findings, the authors recommend the following steps to preserve the temporal muscle: 1) preserve the STA; 2) prevent injury to the facial branches by using subfascial dissection; 3) use a zygomatic osteotomy to avoid compressing the muscle, arteries, and nerves, and for greater exposure when retracting the muscle; 4) dissect the muscle in subperiosteal retrograde fashion to preserve the deep vessels and nerves; 5) deinsert the muscle to the superior temporal line without cutting the fascia; and 6) reattach the muscle directly to the bone.
颞肌松解是一种常见的神经外科手术操作。遗憾的是，术后肌肉萎缩引起的美容和功能并发症可能很严重。肌肉的正常功能取决于正常的神经支配、血管供应、肌肉张力以及肌纤维的完整性。在本研究中，作者描述了颞肌的解剖结构，并报告了可用于预防其术后萎缩的技术细节。
本研究旨在确定在常见手术解剖过程中颞肌易受损伤的程度。作者研究了7具尸体中该肌肉的解剖结构及其血管供应和神经支配。进行颧骨截骨术，然后通过骨膜下剥离向下松解颞肌，这保留了肌肉并使其动脉和神经成分得以研究。颞肌由一个主要部分和三个肌束组成。该肌肉由颞深神经支配，颞深神经从下颌神经前支分出。血液通过内侧颞深动脉（前支和后支）与外侧颞中动脉（颞浅动脉[STA]的分支）之间丰富的吻合连接供应。
基于这些解剖学发现，作者建议采取以下步骤来保留颞肌：1）保留STA；2）通过筋膜下剥离防止对面部分支的损伤；3）使用颧骨截骨术避免压迫肌肉、动脉和神经，并在牵拉肌肉时获得更大的暴露；4）以骨膜下逆行方式解剖肌肉以保留深部血管和神经；5）在不切断筋膜的情况下将肌肉止点松解至颞上线；6）将肌肉直接重新附着于骨。
