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Reconstruction of palatomaxillary defects following cancer ablation with temporalis muscle flap in medically compromised patients: a 15-year single institutional experience

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Abstract

Objectives

Successful reconstruction of palatomaxillary defects following cancer ablation represents a formidable challenge for surgeons to achieve consistently favorable outcomes. The purpose of this article is to present our experience in oncologic palatomaxillary repair with temporalis muscle flap (TMF) for medically compromised patients who are not ideal candidates for microvascular reconstruction at a Chinese tertiary referral hospital over a 15-year period (1998–2012).

Method

A retrospective chart review was performed to identify patients with compromised medical conditions who underwent oncologic palatomaxillary reconstruction using TMF. Patients’ demographics, clinicopathological variables, and surgical techniques were presented. Postoperative functional and aesthetic outcomes were assessed by measurements and patients self-evaluations.

Results

Sixty-nine TMFs were successfully harvested and used for immediate oncologic palatomaxillary reconstruction in 67 patients (31 males and 36 females, mean age 60.4 years) with diverse primary malignancies. These patients’ co-morbidities included systemic diseases, preoperative chemotherapy/radiotherapy, and elder over 65 years which precluded the ideal utility of free flaps. Fifty-one patients remained alive without disease, while nine had recurrences/metastases and seven died during the follow-up (0.5–10.4 years, mean 3.7 years). All flaps survived with only partial necroses in four cases. Complications and donor-site morbidities were minimal with five transient facial paralysis and four mild diplopia and enophthalmos. Unrestricted diet and mouth opening, intelligible speech, and satisfactory temporal aesthetics were obtained in most patients.

Conclusion

The TMF is a reliable, versatile, and alternative option for oncologic palatomaxillary reconstruction with satisfactory functional and aesthetic outcomes and minimal complications, especially when appropriately selected for those medically compromised patients.

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Acknowledgments

This work was financially supported by National Natural Science Foundation of China (grant no. 81100737), Natural Science Foundation of Jiangsu Province (grant no. BK2011762), Specialized Research Fund for the Doctoral Program of Higher Education (grant no. 20113234120003), and A Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions (grant no. 2011-137).

Conflict of interest

The authors declare no financial interests regarding this work.

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, 136 Hanzhong Road, Nanjing, People’s Republic of China

    Yanling Wang, Jie Cheng, Chunping Yuan, Zhongwu Li, Dongmiao Wang, Xu Ding, Jinhai Ye, Heming Wu, Linzhong Wan, Zhenjiang Tao, Hongbing Jiang & Yunong Wu

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  1. Yanling Wang
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  2. Jie Cheng
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  3. Chunping Yuan
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  4. Zhongwu Li
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  7. Jinhai Ye
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  11. Hongbing Jiang
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  12. Yunong Wu
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Correspondence to Yunong Wu.

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Yanling Wang and Jie Cheng contributed equally to this article.

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Wang, Y., Cheng, J., Yuan, C. et al. Reconstruction of palatomaxillary defects following cancer ablation with temporalis muscle flap in medically compromised patients: a 15-year single institutional experience. Clin Oral Invest 18, 1663–1670 (2014). https://doi.org/10.1007/s00784-013-1135-8

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  • DOI: https://doi.org/10.1007/s00784-013-1135-8

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