One-Stage Zygomaticomandibular Approach for Improved Access to the Hemimaxilla and the Middle Base of the Skull

Abstract

In this report, we describe a 1-stage zygomaticomandibular composite flap for improved access to the retromaxillary space and the base of the skull. The zygoma and the mandible were not detached from the facial musculature or from its overlying tissues, maintaining an optimum bone-soft tissue relationship. The advantage of this approach was the enhanced exposure of the deep lesion, which provided a shorter and wider view to the maxilla, the retromaxillary space, and the base of the skull. Restoration of the skeletal symmetry and the three-dimensional contour of the maxilla was greatly enhanced by using preadapted plates and a stereolithographic model. To the best of our knowledge, no references were found in the literature regarding the use of the same technique for treating defects of similar nature to those described in this article. The deep circumflex iliac artery flap was used to reconstruct the midfacial defect and the base of the skull. The use of the flap provided optimum results because the defect was closed with the muscle that became epithelialized with minimal bulk.