title: Challenges in the reconstruction of bilateral maxillectomy defects.
abstract: OBJECTIVE
  Bilateral maxillectomy defects, if not adequately reconstructed, can result in grave esthetic and functional problems. The purpose of this study was to investigate the outcome of reconstruction of such defects.
  
  
  METHODS
  This is a retrospective case series. The defects were analyzed for their components and the flaps used for reconstruction. Outcomes for flap loss and functional indices, including oral diet, speech, and dental rehabilitation, also were evaluated.
  
  
  RESULTS
  Ten consecutive patients who underwent bilateral maxillectomy reconstruction received 14 flaps. Six patients had malignancies of the maxilla, and 4 patients had nonmalignant indications. Ten bony free flaps were used. Four soft tissue flaps were used. The fibula free flap was the most common flap used. Three patients had total flap loss. Seven patients were alive and available for functional evaluation. Of these, 4 were taking an oral diet with altered consistency and 2 were on a regular diet. Speech was intelligible in all patients. Only 2 patients opted for dental rehabilitation with removable dentures.
  
  
  CONCLUSIONS
  Reconstruction after bilateral maxillectomy is essential to prevent esthetic and functional problems. Bony reconstruction is ideal. The fibula bone free flap is commonly used. The complexity of the defect makes reconstruction difficult and the initial success rate of free flaps is low. Secondary reconstructions after the initial flap failures were successful. A satisfactory functional outcome can be achieved.
authors.affiliation: Assistant Professor, Department of Head and Neck Surgery, Plastic and Reconstructive 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, Plastic and Reconstructive 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: Assistant Professor, Department of Head and Neck Surgery, Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.
authors.forename: Rahul
authors.initials: R
authors.lastname: Buggaveeti
authors.affiliation: Professor, Department of Head and Neck Surgery, Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.
authors.forename: Mohit
authors.initials: M
authors.lastname: Sharma
authors.affiliation: Professor, Department of Head and Neck Surgery, Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Mathew
authors.affiliation: Professor and Head, Department of Head and Neck Surgery, Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.
authors.forename: Subramania
authors.initials: S
authors.lastname: Iyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery*; D008441:Maxillary Neoplasms / Q000601:surgery*; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013524:Surgical Flaps; D055815:Young Adult