The Temporalis Muscle Flap: A Useful Adjunct in Reconstruction of Combined Defects of the Upper and Lower Eyelids

Abstract

BACKGROUND: Eyelid reconstruction following oncological resection remains a challenge. Multiple techniques have been described for isolated upper or lower eyelid defects. OBJECTIVE: To describe the use of the temporalis flap for reconstruction of an eyelid defect involving both the upper and lower eyelids. METHODS: Excision of a basal cell carcinoma was performed. This resulted in full-thickness defects of the upper and lower eyelids, the lateral canthus including upper and lower canthal tendons, the upper right mid-face, temple, lateral two-thirds of the eyebrow and forehead. The tumour was found to be adherent to bone and dissecting deeply into the lateral orbital cavity as well as along the orbital roof. RESULTS: The lateral orbital rim was reconstructed using the prebent titanium mesh implant. A temporalis muscle flap allowed for draping over the reconstructed orbital rim and to provide reconstruction of the tarsal plates of the upper and lower eyelids. The remaining large cutaneous defect, which involved more than half of the lower eyelid, was reconstructed using a large Mustarde cervical facial rotation flap. CONCLUSIONS: The temporalis muscle flap provides abundant well vascularized tissue and has been described for head and neck reconstruction. A novel technique allows reconstruction of both the upper and lower eyelids using the temporalis muscle in combination with local flaps.