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 closed with PMTF. Results: Seven patients met the inclusion criteria (three patients with cancer, two patients with osteoporosis, and two patients with cancer and osteoporosis). Lesions were assessed both clinically and radiographically. All patients healed uneventfully and reported significantly reduced pain after surgery. One patient developed a late complication at the donor site. Conclusions: The removal of necrotic bone combined with radical sinusotomy and closure of the defect with PMTF is a predictable method to treat extensive maxillary MRONJ lesions with a high success rate.