Maxillary tethering of PMMC flap: reducing incidence of superior margin dehiscence

Oral squamous cell carcinoma (OSCC) imposes a significant disease burden, particularly in Asia, often necessitating extensive maxillectomy and reconstruction using pectoralis major myocutaneous (PMMC) flaps for Brown’s vertical class I/II defects. Despite their reliability, PMMC flaps commonly suffer superior margin dehiscence due to gravitational pull on the palatal mucosa inset, leading to oro-cutaneous fistulas.​

A maxillary tethering technique was employed: a full-thickness mucoperiosteal flap was raised at palatal margins, holes drilled in cortical bone at 1 cm intervals using a low-speed handpiece and HP 702 bur with saline irrigation, the PMMC muscle anchored through the bone with interrupted 2 − 0 polyglactin sutures, and the palatal mucosa sutured to the flap skin using 3 − 0 polyglactin in simple interrupted or vertical mattress fashion.​

In this preliminary four-patient series, no superior margin dehiscence or fistula formation was observed during postoperative follow-up at day 7,15 & 20. This cost-effective technique appeared to offer stable bony fixation without additional equipment and with minimal added operative time. However, larger studies with longer follow-up are required before definitive conclusions can be drawn.