Choi Jae Hyeok, Roh Tai Suk, Lee Won Jai, Baek Wooyeol
Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea.
Arch Craniofac Surg. 2022 Aug;23(4):178-182. doi: 10.7181/acfs.2022.00682. Epub 2022 Aug 20.
Postoperative temporal hollowing is a common complication of craniotomy. Damage and repositioning of the temporalis muscle can lead to a depression in the temporal side of the skull with inferior bulging, worsening aesthetic outcomes. We report a case of cranioplasty with three-dimensional (3D) printed mesh involving an additional correction using a temporalis muscle sling to help address this problem. A 3D-printed bioabsorbable mesh was prepared based on preoperative facial computed tomography, and was fixed to the hollowed area for tissue augmentation. The temporalis muscle was elevated and fanned out to its original position, and a sling was attached to a screw that was fixed to the mesh. For reinforcement, an additional sling was attached to another screw fixed to the mesh 2-3 cm vertically above the first screw. Aesthetic results were confirmed immediately after surgery and later during outpatient follow-up. Both depression and lateral bulging were resolved, and there was no delayed drooping of the temporalis muscle on 6-month follow-up. There were no complications, and the patient was satisfied with the appearance. This is a simple yet effective technique with a low risk of complications, and should be considered for postoperative temporal hollowing patients, especially those with severe lateral bulging.
术后颞部凹陷是开颅手术常见的并发症。颞肌的损伤和重新定位可导致颅骨颞侧凹陷并伴有下方膨出，从而恶化美学效果。我们报告一例使用三维（3D）打印网片进行颅骨修补术的病例，该手术还采用颞肌吊带进行额外矫正以解决这一问题。根据术前面部计算机断层扫描制备3D打印的可生物吸收网片，并将其固定于凹陷区域以进行组织填充。将颞肌提起并扇形展开至其原始位置，并用吊带连接至固定在网片上的螺钉。为加强固定，在第一个螺钉垂直上方2 - 3厘米处固定于网片的另一螺钉上附加一个额外的吊带。术后即刻及后期门诊随访均证实了美学效果。凹陷和外侧膨出均得到解决，6个月随访时颞肌无延迟下垂。无并发症发生，患者对外观满意。这是一种简单而有效的技术，并发症风险低，对于术后颞部凹陷患者，尤其是伴有严重外侧膨出的患者应予以考虑。
