Anteriorly pedicled deep layer of temporalis muscle flap for disc replacement after temporomandibular discectomy

An anteriorly pedicled temporalis muscle flap has a functional advantage for temporomandibular (TMJ) joint reconstruction. However, the greater thickness of the flap for disc replacement after discectomy might cause several postoperative complications including malocclusion. The temporalis muscle can be split into the thin superficial and thick deep layers; they are separated by a thin fatty layer. Therefore, we developed the modified anteriorly pedicled temporalis muscle flap using the deep layer of the temporalis muscle, which has a suitable size for the TMJ space after discectomy without losing the functional advantage. The procedure was applied to three patients who underwent discectomy for the treatment of synovial osteochondromatosis. They were followed up from preoperatively to more than 1 year postoperatively. No significant postoperative complication were observed in all patients. Additionally, all patients obtained normal jaw function without malocclusion from immediately after the surgery. This technique offers some advantages in disc replacement after discectomy.