Maxillary reconstruction using microvascular free flaps.
OBJECTIVE
Loss of all or part of the maxilla as a result of tumor ablation has both functional and aesthetic consequences. Reconstruction of the maxilla remains a challenge despite the availability of several flaps and the skills of the prosthodontist. We have analyzed a series of maxillary resections that underwent flap reconstruction to guide planning of the rehabilitation of patients with such defects.


METHODS
The authors present 83 patients with various types of maxillary defects that were reconstructed with different microvascular free flaps. All clinical data, including data on the functional and aesthetic outcome, are analyzed.


RESULTS
Flap transfer was successful in 80 of 83 patients who underwent maxillary reconstruction. Separation of the oral and nasal cavities was achieved in all cases. Flap compromise occurred in 6 cases, which made revision necessary. Three of these flaps were salvaged and 3 flaps failed. In 10 of 28 patients with transferred bone, osseointegrated implants were inserted and dentally rehabilitated with excellent functional and aesthetic results.


CONCLUSIONS
Various types of maxillary defects can be reconstructed successfully using different microvascular free flaps. This procedure is challenging because of the anatomical site of reconstruction creating a steep learning curve. If the reconstruction is successful, both facial appearance and oral function can be improved. Microvascular flaps containing bone of the fibula, scapula, or iliac crest facilitate complete dental rehabilitation.
Mücke
Thomas
T
Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, München, Germany. th.mucke@gmx.de
Hölzle
Frank
F
Loeffelbein
Denys John
DJ
Ljubic
Andreas
A
Kesting
Marco
M
Wolff
Klaus-Dietrich
KD
Mitchell
David A
DA
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000534:rehabilitation / Q000601:surgery; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery*; D008441:Maxillary Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000534:rehabilitation / Q000601:surgery