Temporoparietal osteofascial flap for head and neck reconstruction

This article describes the use of the temporoparietal osteofascial flap (TOF) for reconstruction of bony defects in the midface and mandible.

We reviewed the demographics, etiology, indications, surgical technique, radiographic evaluation, and final outcome of 11 patients with upper or lower jaw defects who underwent reconstruction using the TOF between 1994 and 1999.

The TOF was used to reconstruct a defect of the mandible in 7 patients, the hard palate in 2 patients, the maxilla in 1 patient, and the zygoma in 1 patient. The defect was a result of tumor resection in 9 patients and of trauma in 2 patients. The defect size ranged from 3 to 6 cm. Ten flaps (91%) were successful and 1 flap failed. There was 1 donor site complication (small dural tear) that was repaired immediately without sequelae. One patient had osseointegrated dental implants placed in the bone with good results. Exploration of the construction area was performed in 1 patient 13 months after surgery because of recurrent tumor. It showed a fully integrated bone flap.

This vascularized calvarial bone flap can be used for the reconstruction of small to medium-sized defects of the maxilla and lateral mandible with good functional and cosmetic results. It can be performed without special microvascular expertise and with minimal donor site morbidity. A full-thickness bone flap can support osseointegrated dental implants.