Coronoid-Temporalis Pedicled Flap for Orbital Floor Defect Reconstruction

Zijian Guo; Grace Paka Lubamba; Cheng Miao; Guangzhao Huang; Chunjie Li

doi:10.3791/68816

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Method Article

Coronoid-Temporalis Pedicled Flap for Orbital Floor Defect Reconstruction

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DOI:

10.3791/68816

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December 5th, 2025

Zijian Guo¹^,² , Grace Paka Lubamba¹^,²^,³ , Cheng Miao¹^,² , Guangzhao Huang¹^,² , Chunjie Li¹^,²

¹State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, ²Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, ³Department of Oral and Maxillofacial Surgery, University Clinics of Kinshasa, Faculty of Dental Medicine, University of Kinshasa

Summary

This protocol presents a novel coronoid-temporalis pedicled flap (CTPF) technique for reconstructing small-to-medium orbital floor defects. CTPF avoids microvascular risks while maintaining biomechanical stability. Clinical cases demonstrate effective structural restoration, reduced complications, and preserved facial symmetry, offering a viable alternative to traditional grafts or alloplastic materials.

Abstract

Orbital floor defects may result from maxillary trauma or tumor resection. Traditional reconstruction techniques often rely on vascularized or non-vascularized free bone grafts, which carry risks of graft failure due to thrombosis, infection, or poor integration. This protocol introduces a novel technique using a coronoid-temporalis pedicled flap (CTPF) for repairing small-to-medium orbital floor defects. The protocol involves harvesting the coronoid process with its attached temporalis muscle pedicle, transposing the flap to the orbital floor, contouring the bone to fit the defect, and achieving rigid fixation. When soft tissue coverage is insufficient, additional options such as local advancement or free flaps can be employed. The CTPF technique offers a biomechanically stable, vascularized solution that avoids the complications associated with microvascular anastomosis. It is particularly suitable for moderate defects, though it may not provide sufficient volume for large or complex orbital reconstructions. A representative clinical case illustrates the technical feasibility of this approach and demonstrates anatomic restoration with preservation of facial contour. While quantitative outcomes are not reported, the procedure shows potential as a viable alternative to conventional bone grafts or alloplastic implants.

Introduction

The orbital floor, anatomically formed by the orbital plates of the maxilla, zygomatic bone, and palatine bone, serves as the principal scaffold for orbital soft tissue support. Defects in this region, commonly resulting from tumor resection or trauma, often lead to enophthalmos and diplopia due to loss of structural continuity¹. Current reconstructive approaches primarily rely on two strategies: alloplastic materials (e.g., titanium mesh) or autologous free bone flaps (e.g., fibula or iliac crest grafts)²^,³^,⁴. Titanium mesh, despite its intraoperative....