Comprehensive Facial Reconstruction With Anterolateral Thigh Free Flap After Maxillary Sinus Squamous Cell Carcinoma Resection

Squamous cell carcinoma (SCC) of the maxillary sinus often necessitates extensive surgical resection followed by complex reconstruction and adjuvant therapy. Reconstructive approaches in head and neck surgery have advanced significantly over recent decades, with microvascular free flaps offering superior functional and aesthetic outcomes. We report the case of a 54-year-old male with moderately differentiated SCC of the right maxillary sinus, initially treated with right-sided maxillectomy in 2021 and reconstructed using a forehead local flap. Following adjuvant radiotherapy, the local flap failed within two months, resulting in a large maxillary defect and extensive post-radiation scarring. In January 2025, definitive reconstruction was performed using an anterolateral thigh (ALT) free flap in this fibrotic, irradiated field. Despite the technically challenging dissection, the reconstruction was successful, achieving satisfactory facial contour and proper wound healing. The case highlights the challenges of managing late-stage complications and the importance of free flap repair in facial reconstruction.