_applied sciences_  
_Case Report_  
**Primary Reconstruction of Total Maxillectomy with Custom-Made Subperiosteal Implant and Temporal Muscle Flap: A Case Report**  
[PERSON] 1,2, [PERSON] 2, [PERSON] 2, [PERSON] 2, [PERSON] 3, [PERSON] 2, [PERSON] 4, [PERSON] 4, [PERSON] 5,6 and [PERSON] 1,2,7,*  
Footnote 1: [[https://www.mdpi.com/journal/applsci](https://www.mdpi.com/journal/applsci)]([https://www.mdpi.com/journal/applsci](https://www.mdpi.com/journal/applsci))  
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Footnote 4: [[https://www.mdpi.com/journals/article/pdf/](https://www.mdpi.com/journals/article/pdf/)]([https://www.mdpi.com/journals/article/pdf/](https://www.mdpi.com/journals/article/pdf/))  
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Footnote  
Fibula [5], scapular [6], or iliac crest [7] free flaps currently represent the gold-standard in maxillary reconstruction as they allow the creation of a stable division between the mouth and the nasal and paranasal sinuses, provide adequate projection to the soft tissues of the middle-third of the face, and bring to the recipient site an amount of bone sufficient for the dental implant placement, which can be performed simultaneously with the reconstruction [8]. The loss of dental elements is, in fact, one of the primary causes of reduction in the quality of life of these patients, and implant-prosthetic rehabilitation should, therefore, be considered among the objectives of the treatment [1; 9]. Free flaps represent a sophisticated and well-validated technique but are often challenging to perform, especially in elderly patients or those with severe comorbidities [10]. In such cases, less complex reconstructive solutions are generally used. Specifically, temporalis muscle [11] and bucinator myomucosal flaps [12; 13] represent local solutions with a lower surgical burden for the patient. However, unlike free flaps, they do not allow for bone reconstruction, making implant-prosthetic rehabilitation very difficult [14].  
Subperiosteal implantology was first proposed and developed in Sweden by [PERSON] in the early 1940s [15]. However, the technique never gained popularity due to the difficulties in surgery and the poor long-term results caused by the implant's inadequate fit to the bone [16]. With the advent of endosseous implantology, the technique's popularity further diminished [17].  
In 2017, [PERSON] [18] completely revised the design and manufacturing technique of subperiosteal implants for the rehabilitation of severe maxillary atrophy. Computer-Aided Design and Computer-Aided Manufacturing (CAD/CAM) and laser melting technologies enabled the creation of implants with a perfect fit on the bone, based solely on the preoperative CT scan, eliminating the need for a first surgery to take a bone impression of the jaw [18; 19]. Furthermore, applying the concepts of rigid fixation on the maxillary buttresses allowed the surgeon to move the screws away from the surgical wound and provided a firm anchor for the implant to the maxilla, overcoming the problems that reduced the long-term success of first-generation subperiosteal implants [20; 21; 22].  
Few authors have reported the use of subperiosteal implants, either alone or in combination with fibula flaps, for the secondary reconstruction of patients who have undergone maxillectomy [23; 24; 25; 26; 27]. In this report, we present the case of a primary reconstruction using a subperiosteal implant and a temporalis muscle flap in a patient undergoing maxillectomy for squamous cell carcinoma.