title: Brown class III maxillectomy defects reconstruction with prefabricated titanium mesh and soft tissue free flap.
abstract: BACKGROUND
  Midface reconstruction is one of the most challenging tasks for the reconstructive surgeon. We present a technique for the reconstruction of the midface after total maxillectomy with preservation of orbital contents.
  
  
  METHODS
  Skeletal reconstruction is achieved with a preoperatively bent titanium sheet mesh on a universal skeletal model. The alveolar ridge, the anterior wall of the maxillary sinus, the zygomatic prominence, the lower orbital rim, and the orbital floor are reconstructed with a titanium mesh. A soft tissue free flap, preferably anterolateral thigh free flap, is harvested as well. A part of the flap is deepithelized and put in front of the mesh to prevent exposure, and the other part is used for palatal reconstruction.
  
  
  RESULTS
  Four male and 1 female patients were reconstructed with titanium mesh. Four free flaps were raised: 3 anterolateral thigh and 1 latissimus dorsi. All free flaps survived. All patients received postoperative irradiation with 64 Gy. Median follow-up was 12 months; no major complications occurred. Mesh was exposed in only 1 case, which was managed successfully with resuspension of the heavy latissimus dorsi myocutaneous flap. Midface projection and height, globe position, ocular movements, and vision where satisfactory in all cases.
  
  
  CONCLUSIONS
  Midface reconstruction with titanium mesh and soft tissue free flap is a reliable and safe method for functional and aesthetic reconstruction after maxillectomy.
authors.affiliation: Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia. emildediol@yahoo.com
authors.forename: Emil
authors.initials: E
authors.lastname: Dediol
authors.forename: Vedran
authors.initials: V
authors.lastname: Uglešić
authors.forename: Vedran
authors.initials: V
authors.lastname: Zubčić
authors.forename: Predrag
authors.initials: P
authors.lastname: Knežević
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery*; D008441:Maxillary Neoplasms / Q000601:surgery*; D008875:Middle Aged; D010159:Palate / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D000077195:Squamous Cell Carcinoma of Head and Neck; D013526:Surgical Mesh; D014025:Titanium
chemical_list: D014025:Titanium