title: Reconstruction of palatomaxillary defects following cancer ablation with temporalis muscle flap in medically compromised patients: a 15-year single institutional experience.
abstract: OBJECTIVE
  Successful reconstruction of palatomaxillary defects following cancer ablation represents a formidable challenge for surgeons to achieve consistently favorable outcomes. The purpose of this article is to present our experience in oncologic palatomaxillary repair with temporalis muscle flap (TMF) for medically compromised patients who are not ideal candidates for microvascular reconstruction at a Chinese tertiary referral hospital over a 15-year period (1998-2012).
  
  
  METHODS
  A retrospective chart review was performed to identify patients with compromised medical conditions who underwent oncologic palatomaxillary reconstruction using TMF. Patients' demographics, clinicopathological variables, and surgical techniques were presented. Postoperative functional and aesthetic outcomes were assessed by measurements and patients self-evaluations.
  
  
  RESULTS
  Sixty-nine TMFs were successfully harvested and used for immediate oncologic palatomaxillary reconstruction in 67 patients (31 males and 36 females, mean age 60.4 years) with diverse primary malignancies. These patients' co-morbidities included systemic diseases, preoperative chemotherapy/radiotherapy, and elder over 65 years which precluded the ideal utility of free flaps. Fifty-one patients remained alive without disease, while nine had recurrences/metastases and seven died during the follow-up (0.5-10.4 years, mean 3.7 years). All flaps survived with only partial necroses in four cases. Complications and donor-site morbidities were minimal with five transient facial paralysis and four mild diplopia and enophthalmos. Unrestricted diet and mouth opening, intelligible speech, and satisfactory temporal aesthetics were obtained in most patients.
  
  
  CONCLUSIONS
  The TMF is a reliable, versatile, and alternative option for oncologic palatomaxillary reconstruction with satisfactory functional and aesthetic outcomes and minimal complications, especially when appropriately selected for those medically compromised patients.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, 136 Hanzhong Road, Nanjing, People's Republic of China.
authors.forename: Yanling
authors.initials: Y
authors.lastname: Wang
authors.forename: Jie
authors.initials: J
authors.lastname: Cheng
authors.forename: Chunping
authors.initials: C
authors.lastname: Yuan
authors.forename: Zhongwu
authors.initials: Z
authors.lastname: Li
authors.forename: Dongmiao
authors.initials: D
authors.lastname: Wang
authors.forename: Xu
authors.initials: X
authors.lastname: Ding
authors.forename: Jinhai
authors.initials: J
authors.lastname: Ye
authors.forename: Heming
authors.initials: H
authors.lastname: Wu
authors.forename: Linzhong
authors.initials: L
authors.lastname: Wan
authors.forename: Zhenjiang
authors.initials: Z
authors.lastname: Tao
authors.forename: Hongbing
authors.initials: H
authors.lastname: Jiang
authors.forename: Yunong
authors.initials: Y
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery*; D009369:Neoplasms / Q000628:therapy*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013524:Surgical Flaps