Extended Paramedian Forehead Flap for Total Upper Lip: A Case Report

Abstract

A 64-year-old man was diagnosed with squamous cell carcinoma of the palate. His original resection of the palate, maxilla, and total lip was reconstructed with a temporal parietal fascial rotation flap followed by a maxillary reconstruction utilizing a fibula-free bone transfer. He underwent a right neck dissection as well as postoperative radiation.One year later on follow-up, he was found to have upper lip retraction and collapse of the maxilla and underwent bone graft as well as a split thickness skin graft to the upper lip. On further follow-up, his lip continued to retract and he had breakdown at the leftmost aspect of the former flap and part of his plate was exposed (Figure 1). Further reconstruction was then planned with an extended paramedian forehead flap (PMFF; Figures 2-4). He had close follow-up over the years showing success of this flap. Although recommendations for further reconstruction to continue to improve the cosmesis of the flap were suggested, the patient was satisfied with his appearance. His most recent follow-up was 4 years after surgery (Figure 5). He has had dental implants into his neomaxilla (fibula-free flap). He remains cancer free.