Titanium mesh reconstruction to maintain scalp contour after temporalis musculofascial flap reconstruction of the floor of the middle cranial fossa: A technical note and report of two cases

Objective: Temporalis musculofascial rotational flaps can provide excellent tissue for reconstruction of defects in the floor of the middle cranial fossa. This technique can, however, result in cosmetic deformity of the temporal fossa with an asymmetric contour of the head. We report a technique that uses titanium mesh and autologous abdominal adipose to maintain a normal scalp contour. Clinical Presentation: Two patients, one with a large middle cranial fossa and infratemporal schwannoma, and another with penetrating trauma secondary to a rifle accident, required surgical repair of defects of the floor of the middle cranial fossa. Intervention: The repair was achieved in both cases using a temporalis musculofascial rotational flap. Normal contour of the scalp was maintained with titanium mesh and autologous abdominal adipose reconstruction. Conclusion: The temporalis musculofascial flap, combined with titanium mesh and autologous adipose reconstruction, provided excellent closure of defects of the floor of the middle cranial fossa while preserving normal cosmetic scalp contour.