Orofacial reconstruction with pedicled temporal myofascial flap following hemimandibulectomy for mandibular Ewing sarcoma in a resource-limited setting: a case report

Introduction: Orofacial reconstruction after major tissue loss is challenging in resource-limited settings, and few techniques using a pedicled temporalis myofascial flap have been reported. We report a case of orofacial reconstruction and rehabilitation after chemotherapy and hemimandibulectomy for Ewing’s sarcoma. Case presentation: A 65-year-old teacher presented with severe tissue loss on the left side of the face after having an Ewing sarcoma removed 7 months earlier following chemotherapy and surgery. However, the patient could no longer speak or eat and was fed via a nasogastric tube. His evaluation revealed a large opening connecting the mouth to the exterior, extending across about two-thirds of the cheek. The surgeon reconstructed the defect with a pedicled temporalis myofascial flap with key modifications to the standard technique, including reinforcement with the zygomatic muscle. After sessions of physical therapy and work with a speech-language pathologist, the patient reported that the orofacial reconstruction, masticatory function, and speech were satisfactory. The follow-up period was 3 months, after which the patient was discharged to undergo the second phase of chemotherapy. Discussion: There are alternative approaches for orofacial surgical reconstruction using the temporal myofascial pedicled flap; however, modifications to the surgical technique and the ease of flap transposition were crucial in this resource-limited setting. Conclusion: Although the use of a temporal myofascial pedicled flap is uncommon in resource-limited countries, when combined with rehabilitation, it can serve as an alternative treatment for major orofacial tissue loss and restore function.