Use of temporo-myofascial flap for reconstruction of maxillary defect in a case of ameloblastoma

Abstract

Maxillary ameloblastoma is a benign odontogenic neoplasm. Excision should involve wide margins because of its high recurrence rate and, ideally, be followed by reconstruction. A 23-year-old female patient presented with recurrent ameloblastoma. The recurrent lesion was managed by a total maxillectomy preserving the inferior orbital rim. Reconstruction of midfacial defects after tumor resection or trauma has evolved from skin graft to pedicled flaps and more recently, to free tissue transfer. Each of these reconstructive modalities has its specific indications, advantages, and drawbacks. In our case simultaneous reconstruction was performed with a temporalis myofascial flap for obliteration of the maxillary sinus and nasal cavities. Temporalis muscle is one of the regional flaps that can be used to reconstruct midfacial defects. The muscle is available close to the surgical field and has a constant vascular supply. However, the flap has a limited arc of rotation and most of the muscle bulk is used in the pedicle. Therefore, various modifications of the surgical procedure were attempted in order to increase the arc of rotation of the flap. The temporalis muscle flap can provide a reliable, one-stage reconstructive alternative for more complicated surgical procedures for moderate-sized midfacial defects.