Does the Deep Layer of the Deep Temporalis Fascia Really Exist?

Study Overview
=================
Brief Summary
-----------------
It has been widely accepted that a split of the deep temporal fascia occurs approximately 2 to 3 cm above the zygomatic arch, named the superficial and deep layers. The deep layer of the deep temporal fascia lies between superficial temporal fat pad and the temporal muscle. However, during the investigators' previous surgeries, the investigators did not find the deep layer of the deep temporal fascia between superficial temporal fat pad and the temporal muscle. This study was conducted to clarify the presence or absence of the deep layer of the deep temporal fascia. And the investigators' clinical study has confirmed the absence of the deep layer of the deep temporal fascia between superficial temporal fat pad and the temporal muscle.

Detailed Description
-----------------
The anatomic layers of soft tissues of the temporal region, with regard to the deep temporalis fascia, was investigated in 169 cases operated upon with zygomaticofacial or craniofacial fractures using the supratemporalis approach from June 2013 to June 2017. Among 167 surgeries, this so-called deep layer of the deep temporalis fascia was not observed. In fact, the superficial temporal fat pad is closely attached to temporal muscle above the zygomatic arch.

Official Title
-----------------
A New Discovery on the Temporal Fascial Layers: Does the Deep Layer of the Deep Temporalis Fascia Really Exist?

Conditions
-----------------
Anatomy, Temporal Region Trauma

Intervention / Treatment
-----------------
* Procedure: The supratemporalis approach


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Clinical and imaging diagnosis of zygomaticofacial or craniofacial fractures A need to operate using the supratemporalis approach No previously surgical treatment Exclusion Criteria: unobvious displaced fracture disagree with the surgical treatment previous unsuccessful surgery at the temporal region

Ages Eligible for Study
-----------------
Minimum Age: 10 Years
Maximum Age: 68 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| the supratemporalis approach<br>patients operated upon with zygomaticofacial or craniofacial fractures using the supratemporalis approach | Procedure: The supratemporalis approach<br>* The incision differs according to specific fracture sites. It can be a hockey stick-shaped incision, hemicoronal incision, and full coronal incision. The first layer of dissection was just under the superficial temporalis fascia.Then, approximately at the level of 3-5cm above the zygomatic arch, our modified incision was carried through the deep temporalis fascia.Next, the superficial fat pad was encountered and retracted anteriorly, which was in close contact of the temporal muscle. Finally, a flap that included skin, subcutaneous tissue, the superficial temporal fascia, the areolar fat tissue, the deep temporalis fascia and the superficial temporal fat was reflected as a whole anteriorly, fully exposing the temporal muscle and zygomatic arch.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| deep layer of the deep temporal fascia | the investigators did not find the deep layer of the deep temporal fascia between superficial temporal fat pad and the temporal muscle | during surgery | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Temporal anatomy, Deep temporal fascia, Deep layer of the deep temporal fascia, Superficial layer of the deep temporal fascia, Temporal fascial layers