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Microvascular Free Flap Reconstructive Options in Patients With Partial and Total Maxillectomy Defects
Rudy J. Triana Jr., MD;
Vedran Uglesic, MD;
Miso Virag, MD;
Sinisa G. Varga, DDS;
Predrag Knezevic, MD;
Aleksandar Milenovic, MD;
Naranja Aljinovic, MD;
Craig S. Murakami, MD;
Neal D. Futran, MD, DMD
Arch Facial Plast Surg. 2000;2:91-101.
Objective To evaluate and discuss the free flap reconstructive options for patients with partial and total maxillectomy defects.
Design Retrospective review of cases.
Setting Two tertiary referral centers.
Patients Fifty-one patients had partial or total maxillectomy defects resulting from oncologic surgical resection, and 7 had partial maxillectomy defects resulting from trauma. Inferior or partial maxillectomy defects included 10 anterior arch and hemipalate defects and 12 subtotal or total palate defects. Total maxillectomy defects with and without orbital exenteration included 36 maxilla defects with hemipalate and malar eminence.
Intervention There were 11 fibula, 14 rectus abdominis, 9 scapular, 10 radial forearm, 5 latissimus dorsi, and 13 combination latissimus dorsi and scapular flaps.
Main Outcome Measures Separation of the oral cavity from the sinonasal cavities, diet, type of dental restoration, type of orbital restoration, speech intelligibility, and complications.
Results Only 1 flap failure was reported. There was loss of bone in 2 flaps and loss of the skin paddle in 1 flap. All palatal defects were sealed by the separation of the oral and sinonasal cavities. Thirty-eight patients were able to eat a regular diet while the remaining patients maintained a soft diet. All patients conversed on the telephone without difficulty in intelligibility. Eight patients had an implant-borne dental prosthetic, and 30 patients had a conventional partial prosthetic. Orbit restoration was achieved in 2 patients with an implant-borne prosthetic, and 6 patients retained a standard orbit prosthetic.
Conclusions Free flap reconstruction of the maxilla creates reproducible permanent separation of the oral and sinonasal cavities in a single-stage procedure. In addition, there exists the potential for dental rehabilitation with restoration of masticatory and phonatory function. Free flap reconstruction also provides a good cosmetic result, which improves patients' outlook and contributes to their overall well-being. Reconstructive flaps are designed to fit specific maxillary defects and patient needs to provide optimally functional and cosmetic results.
From the Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill (Dr Triana); the Department of Otolaryngology–Head and Neck Surgery, Wake Medical Center, Raleigh, NC (Dr Triana); the Department of Maxillofacial Surgery, University of Zagreb School of Medicine, Zagreb, Croatia (Drs Uglesic, Virag, Varga, Knezevic, Milenovic, and Aljinovic); and the Departments of Otolaryngology–Head and Neck Surgery, Virginia Mason Clinic (Dr Murakami) and University of Washington School of Medicine (Dr Futran), Seattle, Wash.
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