Reverse Temporalis Muscle Flap: Treatment of Large Anterior Cranial Base Defect with Direct Intracranial-nasopharyngeal Communication

Inadequately managed frontal sinus fracture or sinusitis can pose a major problem of intracranial-nasopharyngeal communication. Life-threatening ascending infection of the intracranium is inevitable unless the intracranium is separated from the nasopharynx. In five patients with frontal bone defect associated with direct intracranial-nasopharyngeal communication, the authors used reverse temporalis muscle flap based on the superficial temporal vessels to obliterate the nasocranial communication. With the authors' method, the nasocranial communication were sealed off permanently, and the ascending infection from intracranial-nasopharyngeal communication was controlled successfully. The reverse temporalis muscle flap, which survives by reversed arterial flow through the vascular connection, exists between the superficial temporal artery and the deep temporal artery in the region of temporalis muscle origin. The reverse temporalis muscle flap is versatile and is recommended especially when other local flaps are not available to obliterate the nasocranial communication.