Santiago Gabriel F, Terner Jordan, Wolff Amir, Teixeira Jeffrey, Brem Henry, Huang Judy, Gordon Chad R
Neuroplastic and Reconstructive Surgery, Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore.
Department of Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD.
J Craniofac Surg. 2018 Oct;29(7):1723-1729. doi: 10.1097/SCS.0000000000004639.
An irregular craniofacial contour along the temporal fossa, known commonly as 'temporal hollowing deformity,' (THD) can arise from multiple etiologies. In fact, up to half of all patients who undergo neurosurgical pterional dissections develop some form of temporal contour deformities. Unfortunately, temporal hollowing correction remains surgically challenging with many techniques resulting in high rates of failure and/or morbidity.
Herein, we describe anatomy contributing to postsurgical temporal deformity as well as time-tested prevention and surgical correction techniques. In addition, a review of 25 articles summarizing various techniques and complication profiles associated with temporal hollowing correction are presented.
Complications included infection, implant malposition, revision surgery, pain, and implant removal because of implant-related complications Augmentation with either autologous fat or dermal filler is associated with the highest number of reported complications, including catastrophic events such as stroke, pulmonary embolism, and death. No such complications were reported with use of alloplastic material, use of autologous bone, or free tissue transfer. Furthermore, careful attention to adequate temporalis muscle resuspension and position remain paramount for stable restoration of craniofacial symmetry.
Catastrophic complications were associated with injection augmentation of both fat and dermal filler in the temporal region. In contrast, use of alloplastic materials was not found to be associated with any catastrophic complications. As such, for the most severe cases of THD, we prefer to employ alloplastic reconstruction.
颞窝处不规则的颅面轮廓，通常被称为“颞部凹陷畸形”（THD），可由多种病因引起。事实上，在所有接受神经外科翼点入路手术的患者中，多达一半会出现某种形式的颞部轮廓畸形。不幸的是，颞部凹陷矫正手术仍然具有挑战性，许多技术导致高失败率和/或高发病率。
在此，我们描述了导致术后颞部畸形的解剖结构以及经过时间考验的预防和手术矫正技术。此外，还对25篇总结与颞部凹陷矫正相关的各种技术和并发症情况的文章进行了综述。
并发症包括感染、植入物位置不当、翻修手术、疼痛以及因植入物相关并发症而取出植入物。自体脂肪或真皮填充剂填充引起的并发症报告数量最多，包括中风、肺栓塞和死亡等灾难性事件。使用异体材料、自体骨或游离组织移植未报告此类并发症。此外，对于稳定恢复颅面对称性而言，仔细注意颞肌的充分重新悬吊和位置仍然至关重要。
颞部脂肪和真皮填充剂注射填充与灾难性并发症相关。相比之下，未发现使用异体材料与任何灾难性并发症相关。因此，对于最严重的THD病例，我们更倾向于采用异体材料重建。
