Can Temporal Muscle Reduction Be Done For A Detached Muscle?

Q: Dr. Eppley, I am a 39 year old male who had a left-sided sphenoid wing meningioma removed two years ago. The temporalis muscle didn’t reattach properly and is bunched above the zygomatic arch. I was wondering if you had experience correcting this asymmetry. You mention patients not losing function with a reduction of the posterior temporalis. Have you had the same results with the anterior temporalis? I’m am going to get Botox injections into the muscle bulge in a few weeks. If this doesn’t work well what are my surgical options? Thank you very much for your time.

A: Your pictures show well a detached anterior edge of the temporalis muscle which has contracted and bunched up done at the zygomatic arch as you correctly surmised. Since it is not possible to free up the muscle and stretch it out and resuspend it, temporal muscle reduction of the bulge would be the only treatment approach. Unlike the posterior temporalis, the large anterior belly of the temporalis muscle does carry with it some greater functional significance since it is attached directly to the coronoid process of the mandible. I think the approach of Botox injections is worthy of an initial treatment approach. Sometimes that can work extremely well while in others other moderate muscle reduction is obtained. This muscle bulge can be reduced surgically and that may be reasonable with augmentation higher up in zone 2 of the muscle since that now has more hollowing than the other side due to the muscle retraction. But I would first see how effective Botox may be before considering that approach.

Dr. Barry Eppley

Indianapolis, Indiana