Pedicled myofascial temporalis flap for closure of large maxillary defects after medication-related osteonecrosis of the jaws. A case series

BACKGROUND: Medication-related osteonecrosis of the jaws (MRONJ) located in the maxilla may lead to challenging oro-antral and oro-nasal defects too extensive to be predictably closed with local soft tissue flaps. The use of a pedicled myofascial temporalis flap (PMTF) is, however, well-established for closing large maxillary defects following ablative craniomaxillofacial surgery. OBJECTIVES: The purpose of the present study was to evaluate the use of PMTF for maxillary defect closure in patients with stage 3 MRONJ. METHODS: A retrospective cohort study was conducted based on data from the Copenhagen ONJ cohort from 1 January 2005 to 31 December 2024. The inclusion criteria were consecutive patients with extensive maxillary defects after surgical treatment of MRONJ and reconstruction with PMTF. RESULTS: Seven patients met the inclusion criteria (three with cancer, two with osteoporosis, and two with both conditions). All defects were successfully closed using the PMTF. Healing was uneventful in all patients at the recipient site, with complete mucosal closure achieved. Postoperative pain was reduced in all cases. One patient developed a late donor-site complication requiring removal of the temporal implant; no flap-related failures occurred. CONCLUSIONS: The removal of necrotic bone combined with radical sinusotomy and closure of the defect with PMTF appears to be a feasible approach for managing extensive maxillary MRONJ lesions, with favourable outcomes observed in this limited cohort.