Simple maxillary reconstruction using free tissue transfer and prostheses.
Prosthetic rehabilitation is essential for maintaining postoperative oral function after maxillary reconstruction. However, the maxillary prosthesis becomes unstable in some patients because of extensive palatomaxillary resection and drooping of the transferred flap. In such patients, maintaining sufficient oral function is difficult, especially if the patient is edentulous. To achieve prosthetic retention, the authors performed microvascular maxillary reconstruction with a slit-shaped fenestration in the midline of the hard palate. Maxillary defects after subtotal or total maxillectomy were reconstructed with rectus abdominis musculocutaneous flaps in five patients. Defects of the nasal lining and palate were reconstructed with the single cutaneous portion of the flap, and a slit-shaped fenestration was left between the cutaneous portion of the flap and the edge of the remaining hard palate. Postoperatively, patients were fitted with maxillary prostheses that had a flat projection for the palatal fenestration. In all patients, the prosthesis was stable enough for mastication and prevented nasal regurgitation. Speech function was rated as excellent on Hirose's scoring system for Japanese speech ability. The authors believe that their method of palatomaxillary reconstruction is both simple and reliable.
Sakuraba
Minoru
M
Division of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan. msakurab@east.ncc.go.jp
Kimata
Yoshihiro
Y
Ota
Yojiro
Y
Uchiyama
Kiyotaka
K
Kishimoto
Seiji
S
Harii
Kiyonori
K
Ebihara
Satoshi
S
D000368:Aged; D003131:Combined Modality Therapy; D005153:Facial Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008437:Maxilla / Q000473:pathology / Q000601:surgery; D008441:Maxillary Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D008447:Maxillofacial Prosthesis; D009065:Mouth Rehabilitation / Q000379:methods; D009066:Mouth, Edentulous / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D009669:Nose Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D010348:Patient Care Team; D018714:Radiotherapy, Adjuvant; D012878:Skin Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D013524:Surgical Flaps