Trans-antral Temporal Flap to Reconstruct Palatal Defects in Dentate Patients - A Technical Note

The temporalis myofascial flap (TMF) is a reliable option for midfacial defect reconstruction, benefiting from robust vascularisation and anatomical proximity. However, its use in palatal defect coverage has been limited by the presence of dentition. This article describes a novel TMF transposition technique through a trans-antral pathway, with immediate correction of temporal contour deformity with a titanium mesh. A case of type 2A maxillectomy in a fully dentate patient with a malignant neoplasm shows the technique's feasibility. Key steps include raising the TMF via a hemicoronal approach, rotating it beneath the zygomatic arch, and then through an anterolateral maxillary bone window to reach the palatal vault. The bone window is then reshaped and fixated with plates and screws, and a titanium mesh is contoured to restore the temporal contour. The procedure was completed without complications. The TMF successfully covered the palatal defect, providing a stable foundation for mucosal regeneration. The titanium mesh corrected the temporal depression, restoring soft-tissue contour. Post-operative recovery was uneventful, and no functional or cosmetic deficits were observed. The trans-antral TMF technique is a reliable, single-stage method for palatal defect reconstruction, even in fully dentate patients. This approach is a viable option when microvascular reconstruction is contraindicated or unavailable, offering vascular reliability, minimal donor-site morbidity and reduced operative complexity.