title: A 15-year review of midface reconstruction after total and subtotal maxillectomy:  part I. Algorithm and outcomes.
abstract: BACKGROUND
  Reconstruction of complex midfacial defects is best approached with a clear algorithm. The goals of reconstruction are functional and aesthetic.
  
  
  METHODS
  Over a 15-year period (1992 to 2006), a single surgeon (P.G.C.) performed 100 flaps to reconstruct the following midfacial defects: type I, limited maxillectomy (n = 20); type IIA, subtotal maxillectomy with resection of less than 50 percent of the palate (n = 8); type IIB, subtotal maxillectomy with resection of greater than 50 percent of the palate (n = 8); type IIIA, total maxillectomy with preservation of the orbital contents (n = 22); type IIIB, total maxillectomy with orbital exenteration (n = 23); and type IV, orbitomaxillectomy (n = 19). Free flaps were used in 94 cases (94 percent), and pedicled flaps were used in six (6 percent).
  
  
  RESULTS
  One hundred flaps were performed in 96 patients (69 males, 72 percent; 27 females, 28 percent); four patients underwent a second flap reconstruction due to recurrent disease (n = 4, 4 percent). Average patient age was 49.2 years (range, 13 to 81 years). Free-flap survival was 100 percent, with one partial flap loss (1 percent). Five patients suffered systemic complications (5.2 percent), and four died within 30 days of hospitalization (4.2 percent). Over 50 percent of patients returned to normal diet and speech. Almost 60 percent were judged to have an excellent aesthetic result.
  
  
  CONCLUSIONS
  Free-tissue transfer offers the most effective and reliable form of reconstruction for complex maxillectomy defects. Rectus abdominis and radial forearm free flaps in combination with immediate bone grafting or as osteocutaneous flaps consistently provide the best functional and aesthetic results.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: New York, N.Y. From the Plastic and Reconstructive Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Cordeiro
authors.forename: Constance M
authors.initials: CM
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D005145:Face / Q000601:surgery*; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery*; D008441:Maxillary Neoplasms / Q000601:surgery*; D008875:Middle Aged; D009915:Orbit / Q000601:surgery; D012516:Osteosarcoma / Q000601:surgery; D019651:Plastic Surgery Procedures; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult