Reconstruction of Oromandibular Defects after Prior Irradiation Using a Temporalis Muscle and Temporoparietal Fascia Flap

Abstract

Objectives:

Reconstruction of oromandibular defects in the setting of previous treatment, or significant patient comorbidities, presents a significant challenge. Although free tissue transfer has shown success, it is not without considerable risk, especially in patients with poor baseline functional status. In these patients, regional pedicled flaps may provide a more suitable alternative. The combined temporalis muscle and temporoparietal fascia flap is a versatile option for oromandibular reconstruction in a previously treated field, or in patients with severe comorbidities and poor functional status. Our objective was to report our experience using a combined temporalis muscle and temporoparietal fascia flap for reconstruction of oromandibular defects in high-risk situations.

Methods:

Three patients were identified, medical records were reviewed, and their clinical courses were described. Functional outcomes were reviewed. We include a discussion of the relevant surgical anatomy and operative technique. All patients had previously undergone extensive treatment. They needed additional ablative surgery for different reasons: new malignancy, intractable trismus, and osteoradionecrosis. A combined temporalis muscle and temporoparietal fascia flap was used to reconstruct the oromandibular defects in each patient.

Results:

All flaps survived. Functional status improved in all patients. There were no significant operative or postoperative complications.

Conclusions:

The combined temporalis muscle and temporoparietal fascia flap provides a reliable option for reconstruction of complex oromandibular defects in high-risk situations. In previously treated fields, the transfer of a vascularized flap into the wound hastens healing and improves the quality of native oral cavity tissue.