J Korean Soc Plast Reconstr Surg.  2007 Jul;34(4):447-453.

Long Term Follow Up of Maxilla Reconstruction Following the Ablative Cancer Surgery

Affiliations
  • 1Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea. ahnhc@hanyang.ac.kr

Abstract

PURPOSE: The objective of this study was to evaluate the outcomes of using the free flap in the reconstruction of maxillary defects.
METHODS
27 consecutive cases of maxillary reconstruction with free flap were reviewed. All clinical data were analyzed, including ideal selection of flap, time of reconstruction, recurrence of cancer, postoperative complications, flap design, and follow-up results. The main operative functional items, including speech, oral diet, mastication, eye globe position and function, respiration, and aesthetic results were evaluated.
RESULTS
Among the 24 patients who underwent maxillary reconstruction with the free flap, 14 patients underwent immediate reconstruction after maxillary cancer ablation, and 10 patients underwent delayed reconstruction. There occurred 1 flap loss. Recurrences of the cancer after the reconstruction happened in 2 cases. Postoperative complications were 3 cases of gravitational ptosis of the flap, 2 cases of the nasal obstruction, and 1 case of fistula formation. Out of 27 free flaps, there were 15 latissimus dorsi myocutaneous flaps, 5 radial forearm, 4 rectus abdominis myocutaneous flaps, 1 scapular flap, 2 fibula osteocutaneous flap, respectively. Flaps were designed such as 1 lobe in 9 cases, 2 lobes in 9 cases, and 3 lobes in 5 cases. Among the 14 patients who had intraoral defect or who had palatal resection surgery, 2 patients complained the inaccuracy of the pronunciation due to the ptosis of the flap. It was corrected by the reconstruction of the maxillary buttress and hung the sling to the upper direction. All of the 14 patients were able to take unrestricted diets. In 6 patients who had reconstruction of inferior orbital wall with rib bone graft, they preserved normal vision. Aesthetically, most of the patients were satisfied with the result.
CONCLUSION
LD free flap is suggested in uni-maxilla defect as the 1st choice, and fibular osteocutaneous flap and calvarial bone graft to cover the larger defect in bi-maxilla defect.

Keyword

Maxilla reconstruction

MeSH Terms

Diet
Fibula
Fistula
Follow-Up Studies*
Forearm
Free Tissue Flaps
Humans
Mastication
Maxilla*
Myocutaneous Flap
Nasal Obstruction
Orbit
Postoperative Complications
Rectus Abdominis
Recurrence
Respiration
Ribs
Superficial Back Muscles
Transplants
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