title: Iliac crest internal oblique osteomusculocutaneous free flap reconstruction of the postablative palatomaxillary defect.
abstract: BACKGROUND
  Traditionally, restoration of extensive palatomaxillary defects have been achieved by prosthetic restoration, often with suboptimal functional results. More recently, vascularized bone-containing free flaps have been used for this purpose.
  
  
  OBJECTIVE
  To describe 6 patients who underwent palatomaxillary reconstruction using the composite iliac crest-internal oblique osteomusculocutaneous free flap.
  
  
  METHODS
  Six cases of iliac crest osteomusculocutaneous free flap reconstruction of extensive postablative palatomaxillary defects were retrospectively reviewed with clinical follow-up. We reviewed these cases for pathologic findings, defect size, dental restoration, oral rehabilitation, and speech.
  
  
  RESULTS
  Pathologic findings included squamous cell carcinoma (n = 4), osteogenic sarcoma (n = 1), and sinonasal hemangiopericytoma (n = 1). Mean follow-up was 14.5 months (range, 10-25 months). Four patients underwent resection and reconstruction primarily and 2 underwent reconstruction secondarily. Two patients required reconstruction of a cutaneous defect using the iliac skin paddle. The hard palate and lateral nasal wall were reconstructed in all 6 patients, and the orbital rim and zygomatic body were reconstructed in 4. One patient underwent reconstruction with an orbital prosthesis supported by osseointegrated implants. There was 1 donor site complication and 1 recipient site infection, which was treated successfully with oral antibiotics. Four patients were rehabilitated with osseointegrated implants, and all 6 patients maintain an unrestricted oral diet. All 6 patients have normal speech without velopharyngeal or oronasal insufficiency.
  
  
  CONCLUSIONS
  For extensive palatomaxillary defects, the iliac crest-internal oblique osteomusculocutaneous free flap offers a reliable method of primary reconstruction, allowing for complete orodental rehabilitation without the use of a prosthetic obturator.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Box 1189, The Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Genden
authors.forename: D
authors.initials: D
authors.lastname: Wallace
authors.forename: D
authors.initials: D
authors.lastname: Buchbinder
authors.forename: D
authors.initials: D
authors.lastname: Okay
authors.forename: M L
authors.initials: ML
authors.lastname: Urken
mesh_terms: D000328:Adult; D016025:Bone Transplantation; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006393:Hemangiopericytoma / Q000601:surgery; D006801:Humans; D008297:Male; D008441:Maxillary Neoplasms / Q000601:surgery*; D008875:Middle Aged; D009915:Orbit / Q000601:surgery; D012516:Osteosarcoma / Q000601:surgery; D010157:Palatal Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D012225:Rhinoplasty; D013524:Surgical Flaps; D016896:Treatment Outcome