Reconstrucción de defecto maxilar con colgajo temporal miofascial, un reporte de caso

Abstract

Introduction: Surgical treatment of tumours in oral cavity y maxillary sinus can leave the patient with large defects that may carry with functional and esthetic consequences. Chewing, swallowing y phonation are the main functions compromised with this type of defects. Myofascial temporal flap constitutes a great option for reconstruction with regional flaps because of its vascularization and easy transfer. We present the case of a patient that required reconstructive surgery with a myofascial temporal flap due to an hemimaxillectomy secondary to a squamous cell carcinoma in the right nostril and ipsilateral maxillary sinus.     Method: A 79-year-old patient with no relevant medical history is evaluated in a regional hospital for a mass in the right nostril of months of evolution, the mass occupies the entire nostril and a biopsy of the lesion is taken with a CT scan of the paranasal sinuses. . The biopsy reports an inverted papilloma and the CT shows a mass that occupies the entire right nostril, maxillary sinus and ipsilateral anterior ethmoid with significant bone destruction and areas of intralesional calcification. He was referred to the reference hospital where a right medial maxillectomy was performed endoscopically with prior embolization of the tumor by vascular surgery. The resected piece reports a pathological anatomy of “infiltrating squamous cell carcinoma on inverted papilloma with extensive bone infiltration”. Subsequently, the patient is taken to a median hemimaxillectomy in conjunction with the maxillofacial surgery service, during the intervention it is decided that it is an unresectable lesion due to its large extension. Management with chemo and radiotherapy and an obturator is decided, with adequate adaptation by the patient. Two years later, the patient presented as a sequela an important right orosinusal communication with limitation in his quality of life, reconstruction was performed by maxillofacial surgery with a right temporal myofascial flap. The temporal bone defect is covered with a porous polyethylene prosthesis.   Discussion: The temporal myofascial flap consists of a type III flap according to the Mathes and Nahai classification. Due to its location and great vascularization, it is an excellent option for the reconstruction of defects in the oral cavity, orbit and maxillary sinuses. It is of great importance to recognize the temporal superficial fascia during the surgery to avoid injury to the frontal branch of the facial nerve, which is one of the few risks of using this flap. A favorable aspect of this flap in the reconstruction of the oral cavity is its rapid epithelialization due to the protection against the saliva conferred by the fascia, this allows the early start of radiotherapy if necessary in cancer patients.   Conclusions: The myofascial temporal flap has actual indications that gives it an advantage in reconstruction in cancer patients. Its main advantage is that the defect can be immediately reconstructed. The safety of the vascular pedicle and its proximity to the oral cavity, orbit and middle third of the face, as well as the rapid availability of the flap, make it an excellent option for reconstruction in these areas.