Oral cavity defects occur after resection of lesions limited to the mucosa, alveolar gum, or minimally affecting the bone. Aiming at esthetical and functional improvements of intraoral reconstruction, the possibility of harvesting a new galeo-pericranial free flap was explored. The objective of this study was to assess the technical feasibility of flap harvesting through anatomical dissections and surgical procedure simulations. Ten head and neck specimens were dissected to simulate the surgical technique and evaluate the vascular calibers of temporal and cervical vessels. The procedure was therefore reproduced on a revascularized and ventilated donor cadaver. Anatomical dissections demonstrated that the mean cervical vascular calibers are compatible with superficial temporal ones, proving to be adequate for anastomosis. Perforating branches of the superficial temporal vascularization nourishing the pericranium were identified in all specimens. In conclusion, blood flow presence was recorded after anastomosing superficial temporal and facial vessels in the revascularized donor cadaver, demonstrating both this procedure’s technical feasibility and the potential revascularization of the flap and therefore encouraging its potential in vivo application.

Background and Clinical Significance: Mucormycosis is a rare but potentially fatal opportunistic fungal infection with high morbidity and mortality rates despite aggressive treatment. Rhinocerebral mucormycosis represents the most common form, requiring prompt recognition and multidisciplinary management. Case Presentation: We report a 60-year-old female with glucose intolerance who developed extensive rhinocerebral mucormycosis involving the right maxillary sinus, orbit, and skull base. Despite initial antifungal therapy with amphotericin B, rapid disease progression necessitated radical surgical intervention including complete right hemimaxillectomy, orbital enucleation, and partial sphenoid bone resection with carotid siphon exposure. Initial reconstruction using a free scapular osteocutaneous flap failed due to vascular compromise, requiring salvage coverage with a temporalis muscle flap. Postoperatively, the patient recovered without cerebrovascular complications. Long-term rehabilitation involved implant-supported prosthetic reconstruction with osseointegrated implants placed in the remaining maxilla and fabrication of a custom obturator prosthesis to restore facial support and masticatory function. Conclusions: This case demonstrates the aggressive nature of mucormycosis requiring extensive surgical resection and highlights the challenges of reconstruction in infected tissues. While free flap reconstruction offers theoretical advantages, local tissue options provide reliable coverage when microvascular procedures fail. Comprehensive multidisciplinary care including prosthetic rehabilitation can achieve satisfactory functional outcomes following radical resection.

Mandibular reconstruction using an osteocutaneous free fibular flap is a highly advanced microsurgical procedure, rarely performed in developing healthcare systems due to technical complexity and infrastructure demands. We present the first successful case performed in Tirana, Albania, demonstrating the feasibility of implementing such techniques in emerging surgical settings. A 54-year-old male diagnosed with squamous cell carcinoma of the left mandibular alveolar crest (cT4N1M0) underwent left hemimandibulectomy, bilateral neck dissection and immediate mandibular reconstruction using a right osteocutaneous fibular free flap. Preoperative Doppler ultrasonography confirmed sufficient vascular supply, excluding contraindications such as peripheral vascular disease and venous insufficiency. Fibula was harvested without tourniquet, improving vascular visualization and reducing ischemic time. A 4 × 7 cm skin paddle was included for intraoral soft tissue reconstruction. Cervical recipient vessels were isolated for microvascular anastomosis. Postoperative management involved intensive monitoring by a multidisciplinary team. Flap viability was assessed through color, temperature, capillary refill, and Doppler signals, with early mobilization and speech/swallowing therapy initiated promptly. The patient experienced an uneventful recovery with complete flap survival and functional restoration. This case highlights the potential to achieve complex microvascular reconstructions successfully in resource-limited environments through careful planning and interdisciplinary collaboration.

Background: Odontogenic myxoma (OM) is a rare, benign, but locally aggressive tumor of odontogenic mesenchymal origin. This study aims to expand current knowledge by integrating a concise literature review with a detailed case report of a surgically complex pediatric OM, treated using a biologically advantageous reconstructive technique. Methods: In this study, we report the case of an eight-year-old girl presenting with a large OM that caused complete disruption of the architecture of the left hemimandible. Due to the tumor’s size and bone involvement, radical resection was necessary. A modified extraoral facelift approach was employed to ensure adequate surgical access while avoiding intraoral incisions and minimizing visible scarring. Immediate mandibular reconstruction was performed using an autologous costochondral graft. Discussion: Although infrequently used in modern surgical practice, the costochondral graft offers unique advantages in pediatric patients due to its inherent growth potential and capacity for long-term biological integration. In this case, the graft allowed restoration of mandibular continuity and form with minimal donor site morbidity, demonstrating its viability even today. Conclusions: This case underlines the importance of tailored reconstructive strategies in pediatric OM. The costochondral graft provided excellent functional and esthetic results, with four-year follow-up confirming stable anatomical remodeling and bone regeneration.