Application Of Total Temporalis Flap In Maxillary Defect Reconstruction
Maxillofacial reconstruction; Temporalis flap; Head and neck surgery.
AuthorsABSTRACT• Background: Extensive maxillary defects following oncological resection, particularly advanced or recurrent cases previously treated with surgery and radiation, present a profound challenge in maxillofacial reconstruction. This study evaluates the surgical and functional outcomes of a modified, dualpedicled total temporalis myofascial flap. • Materials and Methods: A descriptive, non-controlled clinical trial was conducted on 33 patients with advanced (Stage III, IVA) or recurrent sinonasal malignancies invading the maxilla. All patients underwent radical resection (achieving R₀ margins) and immediate reconstruction using the total temporalis flap at the Ho Chi Minh City Oncology Hospital between November 2019 and December 2025. Flap viability, aesthetic outcomes, and functional rehabilitation (nasal breathing via NOSE criteria, mastication/deglutition, and speech intelligibility) were evaluated at 3 months postoperatively using Spearman’s rank correlation (Rs). • Results: The mean age was 53.6 ± 4.96 years (M:F ratio ~1:1). Maxillary defects were classified under Brown’s system as Class IIb (n=4), IIIb (n=12), IVa (n=10), and IVb (n=7). The total flap survival rate was 100% (33/33) with zero partial or total necrosis and no CSF leaks; 3 cases of multidrug-resistant infections stabilized within 2 weeks. Optimal speech recovery was remarkably high in Class II and III defects (87.5%) but decreased to 55.6% in Class IV defects (p > 0.05). Masticatory function was well-preserved in primary cases but significantly degraded in patients with recurrent disease (p = 0.010). Conversely, postoperative nasal obstruction was strictly correlated with extensive Class IV defects (p = 0.004, where 77.8% experienced moderate-to-severe obstruction) and a history of radiotherapy (p = 0.013). Aesthetic outcomes demonstrated successful facial symmetry, and no local recurrence has been detected to date. • Conclusion: The total temporalis flap serves as an ideal pedicled reconstructive option for complex maxillary defects. Its robust dual blood supply allows reliable single-stage multi-cavity isolation, rendering optimal functional rehabilitation and structural symmetry despite adverse conditions like prior irradiation or advanced age.
INTRODUCTIONGlobally, the temporalis flap is considered one of the highly effective reconstructive techniques for extensive maxillary defects following oncological resection in the maxillofacial region, particularly for both soft tissue and bony defects. The novelty of this study lies in our application of the total temporalis flap— a composite flap utilizing the entire temporalis muscle and the superficial temporal fascia. This flap is primary vascularized by the deep temporal artery (a branch of the maxillary artery) and augmented by the superficial temporal artery. This approach offers significant advantages over the classic flap, which utilizes either the temporalis muscle or the superficial temporal fascia alone. Consequently, it provides high flexibility, allowing the fascial component to reconstruct the nasal cavity, orbit, or oral cavity, while the muscle component completely obliterates the defect. Due to the dual blood supply from both the deep and superficial temporal vascular pedicles, •••••••••••••••••••••••••••••••• ejprd.org- Published by Riset Publishing Services LLC.
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