Background: The facial artery musculomucosal (FAMM) flap has been reported for the repair and reconstruction of various oral and craniofacial defects. However, reports describing its use for reconstruction of the anterior maxillary region remain limited. Purpose: This report describes the repair of an anterior maxillopalatal defect caused by tertiary syphilis (syphilitic gumma) using a retrograde-flow, superiorly based FAMM flap. Case: A 30-year-old man with a history of human immunodeficiency virus and syphilis infection presented with an anterior palatal perforation measuring 3.5 × 1 × 1 cm, accompanied by diffuse erythema, secondary to tertiary syphilis. Case Management: After confirmation that the patient no longer had active syphilis infection, peripheral ostectomy was performed, followed by closure of the defect using a tunneled FAMM flap. Conclusion: Modification of the FAMM flap with tunneling increases its versatility and facilitates closure of maxillopalatal bony defects caused by tertiary syphilis, potentially reducing the need for secondary revision surgery. The authors support the use of this flap for the management of oral defects of similar size and extent.
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