Transoral Hemimaxillectomy: A Scarless Approach for Resection and Immediate Free-Flap Reconstruction of Extensive Maxillary Fibrous Dysplasia

Maxillectomy conventionally requires a Weber-Ferguson transfacial incision, which leaves a permanent facial scar. We describe a purely transoral hemimaxillectomy in a 28-year-old man with extensive fibrous dysplasia of the left maxilla that had recurred after 3 conservative procedures elsewhere and was progressively narrowing the orbit. The hemimaxilla was removed en bloc through gingivolabial vestibular and palatal mucosal incisions alone, without any facial incision and without endoscopic assistance; down-fracture with Walsham forceps delivered the specimen into the mouth. The dead space was obliterated in the same session with a free rectus abdominis muscle flap. The flap survived completely, and 1 year of clinical and radiologic follow-up showed no recurrence, restored facial symmetry, and no facial scar. By 7 months, the maxillary arch had been restored with a removable partial denture that was worn comfortably on an unrestricted diet. The patient has not returned with recurrent disease in the 11 years since.