Chimeric temporopareital osteofascial and temporalis muscle flap; a novel method for the reconstruction of composite orbito-maxillary defects

Reconstruction of midface defects are extremely challenging owing to the lack of suitable vascularized local flaps. The temporoparietal fascia and temporalis muscle flaps make excellent choices for midface and orbito-maxillary reconstruction. The muscle provides adequate thickness while the fascia yields pliable soft tissues for lining the midface. The temporalis muscle can be divided antero-posteriorly in three parts and medio-laterally in two parts without losing its vascularity due to its segmental vascular supply. These versatile flaps can be used independently, combined or as chimeric flap based on its axial blood supply for the reconstruction of midface. When designed as a chimeric flap it makes an excellent choice for the reconstruction of composite midface defects. With the advent of micro vascular reconstruction these regional flaps are rarely used in maxillofacial reconstruction. We hereby present a case of composite orbito-maxillary defect reconstruction using a novel chimeric reverse temporalis muscle and temperopareital fascia flap with pedicled split calvarial bone.