Superiorly based facial artery musculomucosal flap with maxillary sinus access for palate defects.
A Manfuso, M Forte, G D'Albis et al.
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Case in brief
A patient treated for invasive oral squamous cell carcinoma had a residual Brown class IIa palatal defect after maxillectomy. Reconstruction used a superiorly based, reverse-flow facial artery musculomucosal flap, passed through a lateral maxillary sinus window rather than through the mouth. The flap rotated through 180° and achieved tension-free closure with restoration of the oro-antral barrier; the donor site was closed with a Bichat fat pad flap. No complications were reported. At discharge seven days after surgery, primary healing was satisfactory, with dentition and prosthetic structures preserved.
What made this case unusual
The reverse-flow flap was inserted through a lateral maxillary sinus window, avoiding transoral passage through dentition or prosthetic structures.
Diagnostic / clinical pearl
For a medium-sized palatal defect, trans-sinus passage of a superiorly based reverse-flow FAMM flap may permit tension-free closure while preserving dental and prosthetic structures.