“Orbitomaxillary Complex Reconstruction Using an Antidromic Temporalis Muscle Flap and Calvarial Bone Graft Following Brown IIIA Maxillectomy for Juvenile Ossifying Fibroma: A Case Report”

Abstract

Introduction

Juvenile ossifying fibroma (JOF) is a rare benign fibro-osseous neoplasm characterized by rapid growth, locally aggressive behavior, and a high recurrence rate. Involvement of the orbitomaxillary complex represents a diagnostic and therapeutic challenge due to the proximity of critical functional and aesthetic structures. Defects resulting from extensive maxillectomies require complex reconstruction aimed at restoring orbital support, facial symmetry, and functionality [1–4]. Due to its low prevalence and the limited evidence available regarding reconstructive strategies in these patients, reporting clinical cases remains valuable for expanding current knowledge.

Objective

To describe the complex surgical and reconstructive management of a patient with trabecular and psammomatoid juvenile ossifying fibroma treated with Brown IIIA maxillectomy and orbitomaxillary reconstruction using an antidromic temporalis muscle flap and calvarial bone graft at the National Institute of Rehabilitation “Luis Guillermo Ibarra Ibarra”.

Methodology

We present the case of a 23-year-old female patient with progressive enlargement of the right maxillary region, intermittent pain rated 4/10 on the Visual Analog Scale (VAS), paresthesia, and right-sided nasal obstruction. An incisional biopsy revealed juvenile ossifying fibroma with both trabecular and psammomatoid components. Computed tomography demonstrated a heterogeneous mass with irregular borders, apparently originating from the root region of the right maxillary premolar, causing orbital displacement and contact with the orbital septum. A Brown IIIA maxillectomy according to the Cordeiro classification and right dacryointubation were performed. Reconstruction included an antidromic temporalis muscle flap, an outer-table parietal calvarial bone graft for orbital floor reconstruction, fixation with osteosynthesis material, and autologous fat grafting to restore hemifacial volume.

Results

Histopathological examination confirmed juvenile ossifying fibroma with trabecular and psammomatoid components. Reconstruction successfully restored orbital floor continuity and globe support while preserving facial symmetry and midfacial volume. The patient experienced a favorable postoperative course with adequate graft integration and satisfactory aesthetic outcomes, without major complications during follow-up. The combination of regional vascularized tissue and autologous bone graft provided structural support and appropriate coverage of the defect [2–5].

Conclusions

This case highlights the rarity of juvenile ossifying fibroma with orbitomaxillary involvement, as well as the diagnostic and reconstructive complexity associated with its management. Comprehensive treatment at a tertiary referral center enabled coordinated participation of the Otolaryngology–Head and Neck Surgery and Plastic and Reconstructive Surgery teams, facilitating appropriate oncologic and reconstructive planning. Orbitomaxillary reconstruction using an antidromic temporalis muscle flap combined with a calvarial bone graft proved to be an effective alternative for restoring orbital support, preserving functionality, and improving facial contour. This case underscores the importance of an interdisciplinary approach in the management of complex midfacial defects and provides clinically relevant insights applicable to reconstruction, rehabilitation, and quality-of-life improvement in patients treated at highly specialized centers.