====== Superficial temporal fat pad ======


Contour irregularities in the [[temporal]] region have been reported previously after [[procedure]]s involving [[temporal]] [[dissection]]. 

In a study, Krug et al. reported paradoxical temporal enlargement (PTE) following [[interfascial dissection]] in [[pterional craniotomy]].

A retrospective review of patients who underwent a unilateral transcranial procedure with a [[frontotemporal approach]]  between September 2013 and December 2017 was performed. Patients with a previous [[craniotomy]] or bilateral craniotomy were excluded. Radiological imaging series including [[computed tomography]] and magnetic resonance imaging were utilized to calculate temporal soft tissue volumes both preoperatively and postoperatively by using advanced software technology. Relative soft tissue volume differences between the operative side and the contralateral side were calculated at different time-points including preoperative, 3-months follow-up (3M), 12-months (12M) follow-up, and the last follow-up (LFU, over 1-year).

Forty-three patients were included. Mean age was 52.7 ± 4.5 years. Mean follow-up was 27.9 ± 15.8 months. Significant changes of temporal fat pad relative-volume difference were observed between the preoperative and the corresponding 3M (t [82] = -2.8865, P = 0.0050); 12M (t [77] = -4.4321, P < 0.0001), and LFU (t [74] = -4.9862, P < 0.0001) postoperative time points. No significant change of the [[temporal muscle]] was observed between the preoperative and the corresponding 3M (P = 0.3629), 12M (P = 0.1553), or LFU (P = 0.0715). Soft tissue volume showed a significant increase on the operative side between the preoperative and the corresponding LFU (t [74] = -2.5866, P = 0.0117).

Paradoxical temporal enlargement with more than 10% volumetric change was observed in 24% of the patients at their LFU (>1-year). This change was not due to temporalis muscle changes. Paradoxical temporal enlargement was due to hypertrophy of the [[superficial temporal fat pad]]. Before surgical correction of postoperative temporal contour changes, it is important to obtain imaging and characterize the etiology of the deformity
((Krug RG 2nd, Kuruoglu D, Yan M, Van Gompel JJ, Morris JM, Kamath MJ, Graffeo CS, Sharaf B. Paradoxical Temporal Enlargement: An Expansion of Superficial Temporal Fat Pad Following Interfacial Technique for Pterional Craniotomy. J Craniofac Surg. 2021 Jun 28. doi: 10.1097/SCS.0000000000007730. Epub ahead of print. PMID: 34183631.)).
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Interfascial dissection between two layers of deep temporal fascia through the intermediate fat pad is superior to other approaches because of the lack of facial nerve branches in this plane. The Intermediate fat could be easily separated from deep layer of deep temporal fascia
((Sihag RK, Gupta SK, Sahni D, Aggarwal A. Frontotemporal Branch of the Facial Nerve and Fascial Layers in the Temporal Region: A Cadaveric Study to Define a Safe Dissection Plane. Neurol India. 2020 Nov-Dec;68(6):1313-1320. doi: 10.4103/0028-3886.304113. PMID: 33342860.)).
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Recognizing the IFV in the interfascial space is of great help as an anatomic landmark to confirm that one is actually between both layers of the superficial temporal fascia
((Campero A, Ajler P, Paíz M, Elizalde RL. Microsurgical Anatomy of the Interfascial Vein. Its Significance in the Interfascial Dissection of the Pterional Approach. Oper Neurosurg (Hagerstown). 2017 Oct 1;13(5):622-626. doi: 10.1093/ons/opx047. PMID: 28922882.)).
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No branches of the frontotemporal branches (FTB) are found in the interfascial (between the superficial and deep leaflet of the temporalis fascia) fat pad. The interfascial dissection can be safely performed without risk of injury to the FTB and potential subsequent frontalis palsy
((Spiriev T, Ebner FH, Hirt B, Shiozawa T, Gleiser C, Tatagiba M, Herlan S. Fronto-temporal branch of facial nerve within the interfascial fat pad: is the interfascial dissection really safe? Acta Neurochir (Wien). 2016 Mar;158(3):527-32. doi: 10.1007/s00701-016-2711-x. Epub 2016 Jan 23. PMID: 26801513.))