Does the Deep Layer of the Deep Temporalis Fascia really exist?

Publication date: Available online 14 April 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Hui Li, Kaide Li, Wenhao Jia, Chaoying Han, Jinlong Chen, Lei Liu
PurposeIt has been widely accepted that a split of the deep temporal fascia occurs approximately 2 to 3 cm above the zygomatic arch, into the superficial and deep layers. The deep layer of the deep temporal fascia lies between the superficial temporal fat pad and the temporal muscle. However, during procedures, we noted the absence of the deep layer of the deep temporal fascia between superficial temporal fat pad and the temporal muscle. This prospective study was conducted to clarify the presence or absence of a deep layer of the deep temporal fascia.Materials and MethodsThe anatomic layers of soft tissues of the temporal region, with reference to the deep temporal fascia, were investigated in 130 cases operated upon for zygomaticofacial fractures using the supratemporalis approach from June 2013 to June 2017.ResultsAmong 130 surgeries, we found the absence of a thick, obviously identifiable fascial layer between superficial temporal fat pad and temporal muscle. In fact, we found nothing above the temporal muscle in a majority of cases. In a few cases we observed only a small amount of scattered loose connective tissue between the superficial temporal fat pad and the temporal muscle.ConclusionsOur clinical study has demonstrated the absence of thick, obviously identifiable fascial layer between superficial temporal fat pad and temporal muscle, which suggested that there may not exist a so-called "deep layer of the deep temporal fascia."Clinical RelevanceIt has long been thought that a split of the deep temporal fascia occurs approximately 2 to 3 cm above the zygomatic arch into the superficial and deep layers. However, in our clinical study, we have found the absence of a thick, obviously identifiable fascial layer between superficial temporal fat pad and temporal muscle, which suggested that there may not exist a so-called "deep layer of the deep temporal fascia." Our initial findings are critical in further understanding of the surgical planes and dissection techniques within the temporal region.



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