How to Prevent a Limitation of Mouth Opening Following Fronto-temporal Craniotomy

Abstract

Although a number of operative procedures have been already reported to prevent cosmetic and functional complications following fronto-temporal craniotomy, little has been analyzed concerning the limitation of mouth opening due to the atrophy, fibrosis and contracture of the temporal muscle. Our focus was placed on the changes and degrees of maximum postoperative mouth opening day by day following fronto-temporal craniotomy. We evaluated the efficacy of newly modified craniotomy (n＝17) compared with the previous conventional one (n＝14).Our modified surgical strategy comprises: 1) tailored fascia and pericranium in Z-shaped fashion, 2) gentle manipulation of fascia, pericranium and muscle, and 3) ample humidification of fascia, pericranium and muscle wrapped with soaked saline gauze during operation. In this maneuver, the temporal muscle was firmly anchored to the fascia and pericranium in the original position. Postoperative limited mouth opening of the modified group was quickly (P＜0.05) and fully resolved with statistical significance.

Ventrolateral temporal lobectomy in normal dogs as a counterpart to human anterior temporal lobectomy: a preliminary study on the surgical procedure and complications

“…The most common complications in this study were loss of the menace response and atrophy of the temporal muscles. Visual abnormalities and temporal muscle damage are also common adverse effects in humans [ 31 , 35 , 41 ]. However, their occurrence is thought to be an inevitable secondary iatrogenic effect when the benefits of surgery, i.e., liberation from severe seizures, are considered.…”

“…In human brain surgery, fronto-temporal craniotomy is highly invasive to the temporal muscle [ 3 , 6 , 12 , 21 , 35 ]. Damage to the temporal muscle may include muscle break, muscle fiber damage due to avulsion or traction, blood flow disturbances, nerve transection during surgery, and fibrosis and contracture of the temporal muscle by displacement when the surgical field is closed.…”

“…Surgical complications include skin depression due to temporal muscle atrophy and jaw movement disorders such as a limitation of mouth opening and decreased occlusal function. To reduce these side effects, incisional and closed head reconstruction methods have been studied in humans [ 6 , 35 ], in addition to the importance of protecting muscle tissue during surgery. In the present study, persistent temporal muscle atrophy was observed in three dogs, which may be due to injury from surgical manipulation, as in humans.…”