An anatomical study of the temporal fascia and related temporal pads of fat

Background: Numerous reports have discussed the use of the temporal fascia in reconstructive surgery, an issue mandating a detailed study of the anatomy of this structure and its vasculature. Methods: The material of the present study consisted of 44 specimens, obtained from two stillbirths and 20 embalmed cadavers after injecting the external carotid artery with lead oxide solution. The superficial temporal fascia was visualized by means of radiography to delineate its vasculature. Results: The superficial temporal fascia split into two laminae: superficial and deep, the former being thicker over the lower third of the temporalis muscle resplit into two further layers. Its arterial supply was derived mainly from the superficial temporal artery, describing a proximal tortuous course in 13.6 percent of specimens supplemented by the zygomaticotemporal, zygomaticofacial, and posterior auricular arteries; the musculocutaneous perforators; and the zygomaticoorbital artery in 9.1 percent of specimens. The superficial temporal vein provided the venous drainage. The deep temporal fascia was thicker over the lower half of the temporalis where it split into superficial and deep layers. The fascial branch of the middle temporal artery provided its arterial supply and the muscular branch joined the loose areolar arterial network. Three temporal pads of fat (superficial, intermediate, and deep) were demonstrated. A temporal venous sinus was embedded within the deep and intermediate temporal pads of fat. Conclusions: The superficial temporal artery provides an extra length for raising superficial temporal artery-based flaps. Caution should be exercised whenever the temporalis myofascial flap is raised, to avoid injuring the temporal venous sinus.