Dysfunction of the temporalis muscle following pterional craniotomy: Analysis of 20 cases

  • Muhammad Mukhtar Khan Department of Neurosurgery, Northwest General Hospital & Research Centre, Peshawar
  • FAIQA FILZA KHAN Department of Neurosurgery, Northwest Genera Hospital & Research Centre, Peshawar
  • MUHAMMAD IDRESS Khyber Teaching Hospital, Peshawar
  • MUHAMMAD NAWAZ Department of Neurosurgery, Northwest Genera Hospital & Research Centre, Peshawar
  • KHIAL JALAL Department of Neurosurgery, Northwest Genera Hospital & Research Centre, Peshawar
  • IRFAN JAN Department of Neurosurgery, Northwest Genera Hospital & Research Centre, Peshawar
  • SOHAIL DAUD KHAN Department of Neurosurgery, Northwest Genera Hospital & Research Centre, Peshawar
  • TARIQ KHAN Department of Neurosurgery, Northwest Genera Hospital & Research Centre, Peshawar
Keywords: Temporalis muscle dysfunction, pterional craniotomy, postoperative complications

Abstract

Background & Objectives: Temporalis muscle dysfunction following pterional approach for skull base approaches is commonly encountered which is very discomforting for patients however, literature regarding its management is insufficient. This study presents 20 cases over the course of 4 years and discuss the pitfalls in the management of temporalis muscle dysfunction following pterional craniotomy for various lesions.
Materials and Methods: Sixty patients were operated using the pterional craniotomy, out of which 20 patients were included in the study. In these cases we used three methods of temporalis muscle dissection namely, the submuscular, subfascial & interfascial. Postoperatively, patients were followed for a median of 8 months. Detailed description of the follow-up findings and their statistical associations is presented.
Results: Twenty patients with 12 (60%) males & 8 (40%) females with mean age of 43.8 ± 10.9 years were operated. Twelve (60%) patients were operated using the submuscular approach, 6 (30%) by the subfascial method and 2 (10%) by interfascial technique of temporalis muscle dissection. Of the 20 patients, 8 (40%) reported trismus, 10 (50%) had temporal region and jaw pain and 14 (70%) complained of difficulty chewing. For these patients, we employed local heat therapy (n = 14, 70%), chewing exercises (n = 12, 60%) and oral range-of-motion exercises (n = 9, 45%). 78.5% of patients responded with resolution of pain after local heat therapy, 80% with jaw range-of-motion exercises. The temporal hollowing was assessed by plastic surgeon, but none of the patient pursued plastic surgery intervention.
Conclusion: Temporalis muscle dysfunction following pterional craniotomy occurs in about one-third of patients. It is a cause of significant patient concern. Physiotherapy and oral analgesics can alleviate the common symptoms. Patients must be informed about this complication to avoid undue psychological distress. Early diagnosis & management leads to better patient response.

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Published
2019-06-04
Section
Original Article