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Assessment – Nutrition-Focused Physical Exam to Detect Macronutrient Deficiencies
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
The temporalis muscle is one of the muscles of mastication and is located along the side of the head occupying the temporal fossa. Clenching and unclenching the jaws or teeth contracts this muscle. Standing directly in front of the patient, the examiner should inspect the temporalis muscle for signs of hollowing, scooping, or concave depression. To palpate the temporalis, ask the patient to clench the teeth for muscle engagement. Using the index and middle fingers, palpate the muscle over the temporal bone in a scooping motion forward, backward, and diagonally. In well-nourished patients, there will be ample temporalis muscle and no apparent hollowing or scooping. In severely malnourished patients, inspection will reveal hollowing temples with concave depression. Palpation of the engaged temporalis muscle will feel firm and rigid on well-nourished patients and will feel flaccid and limp in malnourished patients. See Figures 6.2–6.4.
Adapting Injection Techniques to Different Regions
Published in Yates Yen-Yu Chao, Sebastian Cotofana, Anand V Chytra, Nicholas Moellhoff, Zeenit Sheikh, Adapting Dermal Fillers in Clinical Practice, 2022
Yates Yen-Yu Chao, Sebastian Cotofana, Nicholas Moellhoff
Temples show little variations of the curve but different levels of fullness. The temporal fossa is filled with temporalis muscle, different layers of fat, fascia layers, and skin. All these structures contribute to the collective volume of this area. The more artistic issue for temple enhancement is the continuity and transition to the forehead and cheekbones, especially on the temporal lines. Gaps occur here when soft tissue diminishes and would be considered an aging shape. Patients often ask for correction of concave temples that give an impression of the body wasting or suffering (Figure 6.24).
Head and Neck
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
The nerve lies in the temporal fossa and pierces the temporalis fascia 2.5 cm above the zygomatic arch. Procedure: infiltration from the lateral edge of the supraorbital margin to the distal aspect of the zygomatic arch.Specific complications: haematoma formation, increased systemic absorption due to high vascularity.
Internal maxillary artery to middle cerebral artery bypass for a complex recurrent middle cerebral artery aneurysm: case report and technical considerations
Published in British Journal of Neurosurgery, 2022
Ronan J. Doherty, Daragh Moneley, Paul Brennan, Mohsen Javadpour
Preoperatively the patient underwent computed tomographic angiography (CTA) of the head which was used for intraoperative navigation and localisation of the IMAX (Figure 2). Under general anaesthesia, the patient was positioned supine, with the head in the Mayfield head holder and rotated approximately 45 degrees towards the contralateral side. The previous left frontotemporal incision and pterional craniotomy were reopened. The temporalis muscle was reflected inferiorly and a zygomatic arch osteotomy was performed. Under the operating microscope, a temporal fossa craniectomy was performed consisting of removal of bone of the lateral part of middle cranial fossa floor extending medially as far as a line connecting the foramen rotundum and foramen ovale (Figures 3 and 4). The left IMAX was localised in the infratemporal fossa using a combination of CTA-based neuronavigation and micro-Doppler probe (Mizuho Inc. Tokyo, Japan) (Figure 5). In addition, the deep temporal arteries in the deep aspect of the temporalis muscle were followed proximally to lead to the location of the IMAX.
Epidural multi-slitted microporous non-absorbable patch in decompressive craniectomy to facilitate cranioplasty: a preliminary study
Published in British Journal of Neurosurgery, 2018
Sui-To Wong, Wan-Nok Ho, Zhexi He, Kwong-Yui Yam
Developing a surgical plane between the temporalis muscle and the dura is the most technically challenging step when performing cranioplasty for post-decompressive craniectomy defects.1 Often an inner portion of the temporalis muscle is left on the dura to prevent breaching the dura. Thus, the temporal fossa craniectomy edge is obscured by an inner layer of the temporalis muscle, and not exposed. As a result, the bone flap is sandwiched between two layers of the temporalis muscle, and not optimally positioned and fixed to the skull. Surgical techniques have been proposed to facilitate cranioplasty since 2003, using materials such as expanded polytetrafluoroethylene (ePTFE) membrane,2–4 silicone elastomer sheet,5 bovine pericardial patch,6,7 absorbable film,8,9 and silk suture.10 All except the silk suture technique were so-called anti-adhesive techniques. Some of these techniques may create an epidural potential space, and/or are time consuming. An epidural potential space can lead to several adverse effects such as fluid collection, wound infection, and loss of a tight attachment for the temporalis muscle.11,12 To facilitate cranioplasty, preserve the temporalis muscle, and at the same time minimize the aforementioned adverse effects, we placed a single layer of multi-slitted microporous polyesterurethane (MPU) patch between the temporalis muscle and dura during closure of a decompressive craniectomy (epidural MPU patch technique). Our aim is to demarcate the surgical plane between the temporalis muscle and the dura, but avoiding an anti-adhesive effect.
Temporal augmentation with poly methyl methacrylate at the time of autologous cranioplasty
Published in British Journal of Neurosurgery, 2020
Justin R. Davanzo, Scott D. Simon
After obtaining informed consent for the surgical procedures, the patient was brought to the operating room and placed under general anesthesia. The previous craniectomy incision was opened. Once the correct plane was encountered, the scalp flap was carefully elevated off the brain. The temporalis muscle was identified in the temporal fossa and divided. Once the bone edges were appropriately exposed, the autologous cranioplasty was brought into the field. Titanium plates, burr hole covers and screws were used to plate the bone to the intact skull. Because the squamous portion of the temporal bone is often removed during a hemicraniectomy, we often place a small piece of curved titanium mesh in this region. While the bone is being plated, the poly methyl methacrylate is mixed by the surgical technician. The poly methyl methacrylate is allowed to set until it becomes somewhat moldable. Once it has reached this state, we form a small amount of this into a spherical shape. We then place the mixture into the region of the temporal fossa; and, mold it further until the fossa appears to be appropriately filled (Figure 1). Typically, a subgaleal Jackson-Pratt drain is left to decrease seroma formation. Once this is completed, we close the temporalis fascia over top of the implanted poly methyl methacrylate using absorbable suture material. In addition, when able, the temporalis muscle is resuspended in an effort to maintain it in an anatomical postion. Finally, the remainder of the cranioplasty incision is closed in the typical two layer fashion. A post-operative CT was performed as part of routine protocol (Figure 2). Follow up was performed within six weeks of the surgery and no complications were noted.