Facial reconstruction with temporalis muscle flap after orbital exenteration

Abstract

Orbital exenteration and maxillectomy result in functional and aesthetic loss, representing a challenge for reconstructive surgeons. The temporalis muscle flap is a versatile and safe option for plastic surgery. It was first described by Lentz in 1895. In 1898 Golovine described this flap for the reconstruction of the defect after exenteration of the orbit. In 1948 Campbell described its use for the reconstruction of a defect after a maxillectomy6. Our objective was to report the use of pedicle temporalis flap for post-maxillectomy reconstruction and associated orbital exenteration due to squamous cell carcinoma. We report on two cases of giant tumors due to squamous cell carcinomas of the skin with orbital, periorbital and malar involvement. Reconstruction was done with a temporalis flap associated with a skin graft.The study included two female patients, aged 71 and 58 years, respectively, affected by a tumor in- volving he orbital, periorbital and malar regions. Histology confirmed squamous cell carcinoma. Re- construction was done with a temporal pedicle and a skin graft. No morbidity or mortality occurred. The first patient underwent radiotherapy postoperatively, as the resection was R1. Resection for the second patient was R0.Pediculated temporal muscle flap plus a skin graft is a valid option for post-maxillectomy reconstruction with associated orbital exenteration. It allows covering and filling of the area, with acceptable aesthetic and repair results, posing an alternative to the use of free flaps with a lower lear- ning curve and a lower complication rate.