title: Defect components and reconstructive options in composite orbitomaxillary defects with orbital exenteration.
abstract: OBJECTIVE
  The conventional way of reconstructing an orbital exenteration defect associated with a maxillectomy is to cover it with a soft tissue free flap and camouflage it with a spectacle-mounted orbital prosthesis. Also, there are some reports on the use of bone flaps. The objective of this study was to review the reconstructive options for a defect resulting after orbital exenteration and maxillectomy.
  
  
  METHODS
  This study concerns a retrospective case series of 20 patients. Electronic medical records, including clinical details, operative notes, and follow-up data, were analyzed. Defects were analyzed for their reconstructive components. The reconstructive methods used were studied by the types of flap used, bony versus soft tissue types of reconstruction, and the prosthetic method used to rehabilitate the eye. Outcomes were analyzed for flap success rate. Descriptive methods for data analysis were used.
  
  
  RESULTS
  Fourteen patients underwent a soft tissue reconstruction alone and 6 underwent bony reconstruction. The free rectus abdominis was the commonest soft tissue flap used. This article presents the outcome of reconstruction in such patients and the utility of individual flaps for their ability to replace different components of the defect.
  
  
  CONCLUSIONS
  Ideal reconstruction should address all individual defect components of facial contour, orbital, palatal, skull base, and skin defects. The free rectus abdominis flap remains the common choice. When a composite socket reconstruction is to be achieved, the innovative free tensor fascia lata flap with the iliac crest bone and internal oblique muscle is an option.
authors.affiliation: Assistant Professor, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.
authors.forename: Shawn T
authors.initials: ST
authors.lastname: Joseph
authors.affiliation: Associate Professor, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India. Electronic address: drkrishnakumart@yahoo.co.in.
authors.forename: Krishnakumar
authors.initials: K
authors.lastname: Thankappan
authors.affiliation: Professor, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Mathew
authors.affiliation: Professor, Department of Prosthodontics, Amrita School of Dental Sciences, Amrita University, Kochi, Kerala, India.
authors.forename: Manju
authors.initials: M
authors.lastname: Vijayamohan
authors.affiliation: Professor and Head, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.
authors.forename: Mohit
authors.initials: M
authors.lastname: Sharma
authors.affiliation: Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.
authors.forename: Subramania
authors.initials: S
authors.lastname: Iyer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation / Q000379:methods; D005137:Eye, Artificial; D005206:Fascia Lata / Q000637:transplantation; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D009915:Orbit / Q000601:surgery*; D017233:Orbit Evisceration / Q000379:methods*; D021362:Palate, Hard / Q000601:surgery; D010347:Patient Care Planning; D011474:Prosthesis Design; D019651:Plastic Surgery Procedures / Q000379:methods*; D017568:Rectus Abdominis / Q000637:transplantation; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods; D013524:Surgical Flaps / Q000637:transplantation; D016896:Treatment Outcome