maxillectomy defects require bulky and pliable tissue for reconstruction to fill the cavity and maintain the facial contour . the following description is the application of temporal region flaps with forehead flap in a case of cancer maxilla for which suprastructure maxillectomy with skin excision was performed . the case is presented to highlight the management of complex defect with combination of loco regional flaps and its innovative application . he was evaluated and suprastructure maxillectomy ( antrum , orbital floor ) , part of zygoma with skin excision of 5  2 cm was performed by the oncosurgeons [ figures 1 and 2 ] . initially the patient was planned for free alt flap . intraoperatively , we made an alternative plan , because the required skin and soft tissue was relatively less . the reconstruction needs to address the orbital floor , filler for cavity and external skin cover . we planned titanium mesh for orbital floor , temporalis muscle and fascial flap for the cavity and an islanded forehead flap for the skin defect . the temporoparietal fascia along with deep temporal fascia was dissected as a single unit based on the parietal branch of sta , up to the zygomatic arch . this fascial flap was harvested with about 5 cm of pericranium in the distal end to add bulk . next the planned forehead skin flap based on the frontal branch of the sta was elevated [ figure 4 ] . it was used to cover the titanium mesh and was sutured to the surrounding soft tissues [ figure 6 ] . the temporalis muscle was passed through the defect in the anterior part of the zygomatic arch , created by the oncosurgeon during excision . this further aided in the reach of the flap and used as filler in the maxillary antral region . finally the forehead flap was used to cover the skin defect [ figure 7 ] . attempted closure of the forehead donor site caused elevation of the right eyebrow and hence the secondary defect was covered with stsg from scalp . the flap and donor site healed well without any complications . comparison of the pre - operative and post - op pictures at three months follow up showed an aesthetically pleasing and harmonius facial contour [ figures 810 ] . pre - operative planning orbital floor reconstructed with titanium mesh temporoparietal fascia + deep temporal fascia covering the titanium mesh immediate post - operative status pre - operative worm 's eye view post - operative worm 's eye view post - operative frontal view the arterial anatomy and the vascular basis of various temporal flaps were described by h. nakajima et al . skin and superficial temporal fascia networkloose areolar fascia / subgaleal networkdeep temporal fascia networktemporal muscle network 
  skin and superficial temporal fascia network loose areolar fascia / subgaleal network deep temporal fascia network temporal muscle network these vascular networks have good communication with each other . based on this vascular anatomy , dunham was the first to use the sta as a pedicle flap for reconstruction of facial defects in 1893 . demonstrated the possible options of island skin flaps based on the frontal and parietal branches of the sta in the reconstruction of various facial defects . harun et al . has designed the bilobed sta flap based on the frontal branch for defects involving lateral canthus , upper and lower eyelids . obliteration of the cavities in skull base and midface has been a problem with locoregional flaps because of the lack of adequate , bulky vascularised tissue . the muscle and the fascial flap add bulk and also provide a well vascularised tissue withstanding radiation . in the present case , the temporoparietal fascia with deep temporal fascia was used to cover the mesh , the temporalis muscle was used to fill the maxillary cavity . separation of the fascial layer and the muscle also helps in the increased mobilisation and reach of either of the tissues . the facial contour was good with the eyeball in normal position and no post operative diplopia . the contour deformity in the temporal region was camouflaged after hair growth . moreover , the technical difficulties , time taken and financial restraints of a free flap were all avoided . the temporal region is a good donor site because of rich vascular network and availability of different tissues - skin , fascia , muscle , galea , calvarial bone and pericranium . thus , one or more tissues can be harvested depending upon the defect site and nature . the better understanding of the surgical anatomy of this region offers us a suitable alternative to free flaps for suprastructure maxillary defects .
flaps from temporal region have been used for mid face , orbital and peri - orbital reconstruction . 
 the knowledge of the vascular anatomy of the region helps to dissect and harvest the muscle / fascia / skin / combined tissue flaps from that region depending upon the requirement . 
 suprastructure maxillectomy defects are usually covered with free flaps to fill the cavity . here 
 we report an innovative idea in which a patient with a supra structure maxillectomy with external skin defect was covered with chimeric flap based on the parietal and frontal branches of superficial temporal artery and the temporalis muscle flap based on deep temporal artery .