Anterolateral Thigh Skin and Fascia in Facial Skin Defects with Trismus: Two Problems, One Solution

Area of Science:

• Oral and Maxillofacial Surgery
• Reconstructive Surgery
• Plastic Surgery

Background:

• Severe trismus and lateral facial skin loss present complex reconstructive challenges.
• Etiologies include trauma, necrotizing infections, and radiation fibrosis, often leading to significant functional impairment.

Purpose of the Study:

• To evaluate the efficacy of coronoidectomy and condylar excision combined with anterolateral thigh flap reconstruction for treating severe trismus and facial defects.
• To assess the long-term functional outcomes, specifically mouth opening, following this surgical intervention.

Main Methods:

• A case series of five patients with lateral facial skin loss and trismus was treated.
• Surgical intervention involved coronoidectomy and condylar excision to improve mouth opening.
• Anterolateral thigh flap was utilized for soft tissue reconstruction.
• Fascia was employed as an interposition graft to prevent recurrence.

Main Results:

• The surgical technique successfully addressed trismus and facilitated adequate mouth opening in all five patients.
• Two patients with over 9 years of follow-up achieved an average interincisal opening of 40 mm.
• The use of an interposition graft appeared effective in preventing recurrence.

Conclusions:

• Coronoidectomy and condylar excision, coupled with anterolateral thigh flap reconstruction and fascial interposition grafting, represent a viable surgical strategy for complex cases of trismus and facial skin loss.
• This approach can yield durable improvements in mouth opening and functional outcomes.