Pedicled Osseous Reconstruction of Orbital Floor Defects Post-Total Maxillectomy

Malignancies of the maxilla with or without involvement of the maxillary sinus need to be managed aggressively. The surgical process often involves a total maxillectomy that leaves debilitating aesthetic and functional repercussions. When the orbital floor is involved, it is of utmost importance to reconstruct the floor so that adequate support is provided to the orbit and the surrounding structures.

In this technical note, we have discussed two cases and described a local, effective, and aesthetic technique for the reconstruction of the orbital floor post total maxillectomy with a pedicled coronoid-temporalis rotation flap that has shown superior results.

The coronoid-temporalis flap is a local flap that is relatively easy to raise. The dimensions of the coronoid process can be customized to ensure precise adaptation to the orbital floor defect to provide adequate support to the globe. It does not warrant an additional donor site, thus avoiding the incidence of complications associated with free tissue transfer and reducing the overall surgical time. Owing to the high vascularity of the flap, there is significant reduction in the risk of hardware exposure post radiation. Advances in virtual surgery and 3D planning have accounted for better anatomical understanding and precise bone harvesting by utilizing negative templates of the defect and cutting guides.

Coronoid-temporalis flap is a viable option for orbital reconstruction in post ablative defects of maxillectomy involving the floor. The flap acts as an excellent adjunct to other local flaps, free flap, or obturators utilized for maxillary reconstruction.