Utility of Superiorly Based Masseter Muscle Flap for Postablative Retromaxillary Reconstruction

Resections in the posterior component of the oral cavity usually lead to severe functional compromise and lower quality of life for patients. Notable advances in reconstruction of the posterior part of the mouth and of the oropharynx have occurred in recent decades. The anatomic and physiologic rehabilitation of the defect to a reasonable outcome with low morbidity and mortality remains the founding basis of any surgical reconstruction, which also holds true for oral oropharyngeal and retromaxillary reconstructions.

A retrospective chart review study of all patients who underwent surgery for retromaxillary malignancy at the Department of Oral and Maxillofacial Surgery, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital (Nagpur, India) from 2006 to 2015 was performed. Patients underwent selective neck dissection of levels I to IV using wide local excision. The decision for the type of maxillary resection (marginal ostectomy, partial posterior maxillectomy, or hemimaxillectomy) depended on the degree of osseous infiltration of the tumor. Reconstruction was performed in all cases using the regional masseter muscle flap and advancement of the palatal flap into the defect. The necessary findings and observations were tabulated.

Of 76 patients who presented at the hospital, 69 had biopsy specimens positive for squamous cell carcinoma and 7 had biopsy specimens positive for verrucous carcinoma. Twenty-three patients with lesions extending and encroaching into the infratemporal fossa or skull base, distant metastasis, or guarded prognosis were not included in the study. Also excluded from the study were those patients in whom flaps other than the masseteric flap were used primarily for reconstruction. In the remaining 53 patients who underwent resection of retromaxillary malignancy with masseter muscle reconstruction, 48 showed a satisfactory outcome. Postoperative infection was noted in 5 patients and 2 of these patients needed debridement. Postoperative wound contracture with muscular spasm and decreased mouth opening in the early postoperative period were a general observation. In all patients, the vitality of the flap was excellent, with epithelization and adequate mouth opening within 3 weeks. Postoperative speech, swallowing, and facial esthetics were satisfactory and acceptable.

The masseter muscle flap is a promising reconstruction alternative for retromaxillary reconstruction because of advantages such as regional access, ease of harvesting, optimum bulk, flexibility, pliability for larger defects, and minimum postoperative morbidity.