Is the Temporalis Muscle Flap Still Relevant? Indications and Outcomes in Brown Class I-II Mandibular Defects: A Personalized Care Approach

Objective: The role of the temporalis muscle flap in mandibular reconstruction is less clearly defined than its role in maxillary, orbital, and midfacial reconstruction. This retrospective series describes its use for selected Brown class I-II mandibular defects in patients with oral squamous cell carcinoma who were not candidates for microsurgical reconstruction. Methods: Twenty adults treated at San Marco University Hospital in Catania were retrospectively reviewed. Demographic, oncologic, defect-related, reconstructive, and outcome variables were collected from medical records. Outcomes were interpreted descriptively, focusing on flap viability, wound healing, donor-site morbidity, chart-documented function, recurrence, survival status, and follow-up. Results: Defects were Brown class I (n = 3), class IC (n = 1), and class II (n = 16). Stages were T3N0 (n = 4), T4N0 (n = 8), T4N1 (n = 2), T4N2b (n = 2), and T4N3b (n = 4). No flap loss occurred. Wound dehiscence occurred in two patients, corresponding to 100% flap viability and 90% wound-healing success (18/20). Seven patients died during follow-up from systemic disease and were considered separately from local reconstructive outcomes. Follow-up ranged from 5 months to 1 year and 9 months, with a mean of 7 months. Conclusions: In selected medically frail oncologic patients, the temporalis muscle flap may be a pragmatic salvage option for Brown class I-II mandibular defects. The findings are descriptive and hypothesis-generating and do not establish superiority over free-flap reconstruction or long-term oncologic safety.