The temporoparietal fascial flap (TPF) uses fascia from the scalp which is supplied by the superficial temporal artery. It can be used as a pedicled or free flap for reconstruction of facial, orbital, and skull defects. The relevant anatomy is described including landmarks for incision and dissection. Indications include reconstruction of oral, orbital, and cranial defects. Advantages are an easy harvest with a reliable vascular pedicle and low donor site morbidity. Disadvantages include a short pedicle length and potential scarring or alopecia at the donor site.

1. Temporoparietal Fascial Flap
Dr Jameel Kifayatullah
Senior lecturer Khyber College of
dentistry Peshawar ,Pakistan

3. Relevant Anatomy of TPF
• The first layer consists of the skin and subcutaneous
tissue.
• Immediately deep and firmly bound to this layer is
the temporoparietal (sometimes called superficial
temporal) fascia
• The temporoparietal fascia (TPF) is an extension of
the subcutaneous musculoaponeurotic system
(SMAS) inferiorly and the galea aponeurotica
superiorly.

4. Relevant Anatomy of TPF
• Beneath the temporoparietal fascia lies a loose
areolar and avascular tissue layer that separates the
fascia from the temporalis muscular fascia
(sometimes termed the deep temporal fascia).
• division of the temporalis muscular fascia as it
splits into a superficial and deep layer (of the deep
temporal fascia) surrounding a fatty tissue pad at
the temporal line of fusion, approximately 2 cm
above the zygomatic arch

5. Relevant Anatomy of TPF
• The temporalis muscular fascia is
contiguous(touching) with the pericranium
above the superior temporal line and is
contiguous with the masseter muscle fascia
below the arch.
• The superficial temporal artery supplies the
temporoparietal fascia flap

6. Relevant Anatomy of TPF
nerves
• The auriculotemporal nerve, a sensory branch of
the mandibular nerve, lies posterior to the
superficial temporal artery within the
temporoparietal fascia. The frontal branch of the
facial nerve traverses an oblique course over the
zygomatic arch, which can be estimated by a line
connecting a point 0.5 cm inferior to the tragus to
a point 1.5 cm lateral to the superior brow. This
nerve also lies within the temporoparietal fascia,
and flap elevation anterior to the frontal branch
of the superficial temporal artery should proceed
with caution to avoid injuring this nerve

7. Temporalis fascia superficial and deep
layers

8. Relevent anatomy tempoproparietal
fascial flap

10. SMAS
• The Superficial Muscular Aponeurotic System
(SMAS) is a fibrous network that invests the
facial muscles and connects them with the
dermis. It is continuous with the platysma
inferiorly; superiorly it attaches to the
zygomatic arch. In the lower face, the facial
nerve courses deep to the SMAS and the
platysma.

11. Fascia
• A fascia (/ˈfæʃ(i)ə/; plural fasciae /ˈfæʃii/;
adjective fascial; from Latin: "band") is a band or
sheet of connective tissue, primarily collagen,
beneath the skin that attaches, stabilizes, encloses,
and separates muscles and other
internal organs. Fascia is classified by layer,
as superficial fascia, deep fascia,
and visceral or parietal fascia, or by its function
and anatomical location.
• fascia is made up of fibrous connective
tissue containing closely packed bundles of
collagen fibers oriented in a wavy pattern parallel
to the direction of pull.

12. Landmarks
• The important topography of the
temporoparietal flap to mark on the scalp
includes the
• superior temporal line,
• the course of the superficial temporal artery
trunk and the frontal and parietal branches,
• approximate course of the frontal branch of
the facial nerve

13. TOPOGRAPHY

14. The proposed scalp incision has been marked. Note dotted line over
lateral brow marking the course of the temporal branch of the facial
nerve
A

15. incision
• The TPF is initially exposed at the level of the
ear through a pre-auricular facelift incision
which is carried into the hairline. This may be
extended through the scalp in a T or Y pattern;
a zigzag pattern has also been described

16. Identification of superficial temporal
vessels
• The TPF lies immediately deep to the hair
follicles in the pre-auricular area. The
superficial temporal vessels are identified and
the surgeon verifies that the caliber of the
vessels is adequate for flap elevation.

17. Identification of the Superficial
temporal artery and vein
C

18. Epinephrine infiltration
A 1:200,000 epinephrine solution is now
infiltrated into the area of the scalp to control
bleeding from the scalp flaps

19. Elevation of the scalp flap
• Elevation of the scalp flap begins inferiorly where
the plane between the dermis and superficial
temporal fascia is more easily identified
• As dissection proceeds cephalad(cranially),
separation becomes increasingly difficult
secondary to the fibrous connections and the
perforating vessels from the superficial temporal
artery to the overlying scalp. Meticulous
hemostasis is required. Countertraction of the
scalp by an assistant significantly facilitates
dissection

20. Flap size estimation
• After the scalp flaps have been elevated, a
template may be made of the recipient site
defect, and the template may be applied to
the TPFF

21. Extent of dissection
• Anterior dissection is not carried below the
level of the anterior branch of the superficial
temporal artery. Care is also taken to stay far
enough posterior to avoid injuring the
branches of the temporal nerve.

22. Once the overlying skin has been freed from the tpF, the tpF is incised at its superior
margin and elevated along with its pedicle in retrograde fashion. the loose areolar
plane deep to the tpFF is raised along with the flap rather expediently with
visualization of the deep temporal fascia below.
D

23. Raising of TPFF

24. Flap elevation
• The TPF is then incised and elevated along
with its pedicle in retrograde fashion. The
loose areolar plane deep to the TPFF is raised
along with the flap rather expediently with
visualization of the deep temporal fascia
below

25. Dissection
• Dissection then proceeds to the major pedicle.
Dissection is usually stopped at the base of
the tragus. Further dissection into the parotid
gland is not recommended as injury to the
facial nerve may occur. Flap splitting may be
carried out between the major vascular
branches of the STA, usually between the
central and posterior branch or anterior and
posterior branch if two smaller areas require
coverage

26. Dissection then proceeds to the major pedicle. harvest of the deep temporal fascia requires
preservation of the perforat- ing vessel which is identified just inferior to the superior
auricular margin. Once the vascular pedicle of the deep temporal fascia has been identified,
the fascia surrounding the muscle is elevated. Dissection of the main pedicle then proceeds to
the base of the tragus.
Superficial
temporal
fascia flap
Flap can be split
here
ep temporal
fascia
oral branch
acial nerve

27. Indications for TPF
The temporoparietal galea flap is used for
1. Obliteration of oral defects
2. Cranial base reconstruction
3. Obliteration of orbital defects after enucleation
4. Malar augmentation and maxillary and mandibular
reconstruction with vascularized osseous cranial bone
5. Reconstruction of the hair-bearing upper lip or brow
(flap with skin island)
6. Obliteration of a postparotidectomy defect with
preventive treatment for Frey’s syndrome

28. Indications
As a pedicled flap: – Ear (microtia, anotia) and
scalp reconstruction.
• Orbital, maxillary, palatal, and cheek coverage.
• Facial reanimation and lip reconstruction.
• Skull base defects

29. Advantages
• Easy and quick harvesting.
• A very thin flap with a reliable vascular
pedicle.
• Low donor side morbidity with no functional
loss.
• Can be used as a pedicled or free flap.
• A two-team approach is possible.

30. Disadvantages
• Short vascular pedicle (The short pedicle
length of 4 cm may be a challenge in free flap
reconstruction)
• Risk of scarring in the visible area.
• Alopecia along the incision line.
• Limited flap size.