title: A comprehensive algorithm for oncologic maxillary reconstruction.
abstract: BACKGROUND
  Management of maxillary defects is among the most challenging and controversial areas of head and neck reconstruction. The authors develop a treatment algorithm based on outcomes following free flap reconstruction of various maxillary defects.
  
  
  METHODS
  A review of 246 maxillary free flap reconstructions was performed.
  
  
  RESULTS
  The authors' analysis demonstrated that the palatoalveolar resection predicted use of soft-tissue (n = 200) versus osteocutaneous (n = 46) free flaps, depending on the location and extent of the defect. Whether the orbital floor or the entire orbital contents were resected also had implications for flap choice and whether bone grafts or alloplasts were needed. The perioperative complication rate was 37.8 percent, including a 3.3 percent incidence of flap loss. The long-term complication rate was 12.1 percent, including a 7.5 percent fistula rate. Complications related to orbital floor reconstruction were not dependent on the material used (p = 0.18). Greater than 80 percent speech intelligibility was achieved by 95.1 percent of patients, and 90.6 percent tolerated an unrestricted or soft diet.
  
  
  CONCLUSIONS
  To restore both midfacial form and function, the palatoalveolar defect and the status of the orbital floor and orbital contents must be addressed. Defects that involve the anterior maxilla should be addressed with osteocutaneous free flaps if possible, and posterior defects can often be reconstructed with soft-tissue free flaps. The orbital floor requires rigid reconstruction, with either bone grafts or alloplasts, unless the orbital contents have also been exenterated, in which case a soft-tissue free flap should be used to close the orbital cavity.
authors.affiliation: Houston, Texas From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hanasono
authors.forename: Amanda K
authors.initials: AK
authors.lastname: Silva
authors.forename: Peirong
authors.initials: P
authors.lastname: Yu
authors.forename: Roman J
authors.initials: RJ
authors.lastname: Skoracki
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D016025:Bone Transplantation; D003661:Decision Support Techniques; D005260:Female; D058752:Free Tissue Flaps / Q000637:transplantation*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D063175:Mandibular Reconstruction / Q000379:methods*; D008437:Maxilla / Q000601:surgery; D008875:Middle Aged; D009915:Orbit / Q000601:surgery; D021362:Palate, Hard / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D020127:Recovery of Function; D016896:Treatment Outcome