Safe Zones for Temporal Muscle Hook Retraction: A Technical Note

BACKGROUND: The temporal muscle (TM) needs to be dissected and reflected downward in some anterolateral cranial approaches, and failing to preserve its integrity could have severe functional and cosmetic consequences. Most articles focus on techniques to prevent vascular injury during retrograde dissection or techniques to preserve the facial nerve; however, information on how to take care of the muscle during hook retraction is limited. We presented an anatomic study of vascularization of the TM, and we established safe areas for muscular hook retraction. METHODS: We dissected 16 TMs in 8 cadaveric heads. The TM was reflected downward, and we measured the distance between the anterior branch of the posterior deep temporal artery (PDTA) and the frontozygomatic suture and the distance between the posterior branch of the PDTA and the external auditory meatus projection. RESULTS: The average distance between the anterior branch of the PDTA and the frontozygomatic suture was 19.5 mm (range, 14-26 mm). The average distance between the posterior branch of the PDTA and the external auditory canal was 37.1 mm (range, 31-43 mm). We established 2 safe zones for hook placement: an anterior safe zone 14 mm posterior to the frontozygomatic suture and a posterior safe zone 30 mm anterior to the external auditory meatus. CONCLUSIONS: We delimited 2 safe zones for hook placement during TM retraction aiming to avoid direct vascular damage in anterolateral cranial approaches.