Superiorly based facial artery musculomucosal flap with maxillary sinus access for palate defects

Reconstruction of medium-sized palatal defects following maxillectomy represents a major challenge in maxillofacial surgery. The facial artery musculomucosal (FAMM) flap has become a reliable reconstructive option due to its valid vascular supply and mucosal similarity. Numerous technical variants, have expanded its clinical applicability. However, limitations related to flap rotation through dentition or prosthetic structures may compromise outcomes. This note describes a novel surgical technique employing a superiorly based, reverse-flow FAMM flap transposed through a lateral maxillary sinus window. In a patient treated for invasive oral squamous cell carcinoma, the residual class IIa palatal defect, following the Brown classification, was planned to be reconstructed with a superiorly based FAMM flap. A lateral maxillary sinus access was created to allow direct insertion of the flap into the defect, avoiding conventional transoral passage. Donor site closure was achieved using a Bichat fat pad flap. The flap was successfully rotated through a 180° arc and positioned precisely within the defect, achieving tension-free closure and reliable re-establishment of the oro-antral barrier. No complications were observed. The patient was discharged seven days after surgery, with satisfactory primary healing and preservation of dentition and prosthetic structures. Clinical and radiographical follow-ups were performed every 6 months. Trans-sinus application of a reverse-flow FAMM flap represents a novel and versatile approach for medium-sized palatal defect reconstruction, minimizing mechanical trauma, preserving dental and prosthetic integrity, and offering an alternative to free tissue transfer, supporting functional and aesthetic rehabilitation.