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. 2025 May 9;20(3):542-548.
doi: 10.1055/s-0045-1809047. eCollection 2025 Sep.

Comparative Analysis of Bite Force after Cranioplasty with and without Temporalis Dissection in Large Skull Defects Caused by Decompressive Craniectomy

Soumya Deepta Nandi  1 , Raja K Kutty  1 , Jyothish Laila Sivanandapanicker  1 , Sunilkumar Balakrishnan Sreemathyamma  1 , Raj S Chandran  1 , Rosebist Pathrose Kamalabai  1 , Libu Gnanaseelan Kanakamma  2 , Rajmohan Bhanu Prabhakar  1 , Sureshkumar Kunjuni Leela  1 , Anilkumar Peethambaran  1
Affiliations

Comparative Analysis of Bite Force after Cranioplasty with and without Temporalis Dissection in Large Skull Defects Caused by Decompressive Craniectomy

Soumya Deepta Nandi et al. Asian J Neurosurg. .

Abstract

Introduction: Cranioplasty involves repairing the skull defect using an autologous bone flap or synthetic molds. The temporalis muscle, detached during decompressive craniectomy (DC), may be reattached to the bone flap for better cosmetic reconstruction. Along with the masseter and pterygoid muscles, the temporalis muscle significantly contributes to the human bite force. In this study, we analyze patients' bite force in which the temporalis muscle was either dissected and reattached or left undisturbed during cranioplasty.

Materials and methods: All patients who previously underwent DC for traumatic brain injury or stroke were grouped into two, depending on the method of cranioplasty. In group 1, patients underwent temporalis muscle dissection and reattachment to the bone flap or prosthesis. In group 2, the temporalis muscle was left undisturbed. The bite force of the subjects was measured bilaterally in both groups by a gnathodynamometer before cranioplasty and 3 months after the surgery. We compared the difference in bite force of the subjects individually on both sides, preoperatively and postoperatively, as well as between the groups.

Results: This study included 36 patients over 18 years of age, with 18 patients in each group. Preoperatively, the bite force of all the subjects was decreased on the side of the DC compared with the normal side. After cranioplasty, the bite force significantly improved compared with preoperative values in both groups.

Conclusion: Temporalis dissection can be safely done during cranioplasty. There is improvement in bite force after cranioplasty with or without temporalis dissection.

Keywords: bite force; cranioplasty; decompressive craniectomy; temporalis dissection.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
( A ) Intraoperative photo during cranioplasty—the temporalis muscle has been successfully separated from the underlying prosthetic dura and held by two artery forceps. ( B ) The autologous bone flap has been placed over the craniectomy defects. Multiple small holes have been drilled with electric drill. Multiple silk sutures have been passed through these holes and the temporalis muscle and held in suspension. ( C ) The sutures have been firmly tightened and temporalis muscle is resuspended to its original attachment on the autologous bone. ( D ) Intraoperative photo—cranioplasty performed without dissection of the temporalis with patient-specific titanium mold.
Fig. 2
Fig. 2
Photo of the gnathodynamometer.
Fig. 3
Fig. 3
Box plot showing the mean bite force in patients before and after cranioplasty with temporalis dissection. Note the marginal improvement in bite force in the postoperative bite force in this group.
Fig. 4
Fig. 4
Box plot showing the mean bite force in patients before and after cranioplasty without temporalis dissection. There is improvement in bite force in the postoperative bite force in this group also.
See this image and copyright information in PMC

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