Reconstruction of the maxillary suprastructure, the periorbital region, and the lateral pyriform aperature are not commonly performed at the time of oncologic ablative surgery. A significant reason for this practice relates to a paucity of local vascularized soft tissue flaps that can support the reconstruction. Because the local soft tissues do not lend themselves to pedicled or rotational transfer, the most commonly used vascularized tissue for midface reconstruction had been the free tissue transfer. In this article, the pedicled temporoparietal fascial flap is described for midface reconstruction. The donor site from the undersurface of the scalp in the posterior temporal and anterior parietal regions permits the development of a highly vascular, durable, and very supple flap. This flap, pedicled on the superficial temporal artery and vein, can be rotated from the preauricular region, under the zygoma, and through the lateral wall of the maxillary sinus into the midface region for use in supporting bone or skin grafts. The temporoparietal donor site also exposes the appropriate area of the calvarium for external table bone grafts, which can be used in maxillary suprastructure replacement. With this flap, the need for microvascular transfer can be reduced or eliminated in those midface defects limited to the maxillary suprastructure, the periorbital region, and the lateral pyriform aperature.
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