Reconstruction of Midface and Orbital Wall Defects After Maxillectomy and Orbital Content Preservation With Titanium Mesh and Fascia Lata: 3-Year Follow-Up.
OBJECTIVE
To describe the authors' experience in the reconstruction of patients after total maxillectomy with preservation of orbital contents for maxillary tumors using titanium mesh and autogenous fascia lata, where no setting for free flap reconstruction is available.


METHODS
Twelve consecutive patients with paranasal sinus tumors underwent total maxillectomy without orbital exenterations and primary reconstruction. The defects were reconstructed by titanium mesh in combination with autogenous fascia lata in the orbital floor performed by 1 surgical team. Titanium mesh (0.2 mm thick) was contoured and fixed to reconstruct the orbital floor and obtain midface projection. Fascia lata was used to cover the titanium mesh along the orbital floor to prevent fat entrapment in the mesh holes.


RESULTS
The most common pathology was squamous cell carcinoma (50%). Patients' mean age was 45.66 years (33 to 74 yr). The mean follow-up period was 35.2 months (30 to 49 months). During follow-up, no infection or foreign body reaction was encountered. Extrusion of titanium mesh occurred in 4 patients who underwent postoperative radiotherapy. Two cases of mild diplopia at extreme gaze occurred early during the postoperative period that resolved after a few months.


CONCLUSIONS
Placing fascia lata between the titanium mesh surface of the orbital implant and the orbital contents was successful in preventing long-term diplopia or dystopia. Nevertheless, exposure of the titanium implant through the skin surface represented a complication of this technique in 25% of patients. Further studies are required with head-to-head comparisons of artificial materials and free flaps for reconstruction of maxillectomy defects.
Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Otolaryngology Research Center, Imam Khomeini Medical Complex, Tehran University of Medical Sciences, Tehran, Iran.
Maziar
M
Motiee-Langroudi
Professor, Department of Oncologic Surgery, Cancer Institute, Imam Khomeini Medical Complex, Tehran University of Medical Sciences, Tehran, Iran.
Iraj
I
Harirchi
Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Otolaryngology Research Center, Imam Khomeini Medical Complex, Tehran University of Medical Sciences, Tehran, Iran.
Amin
A
Amali
Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Otolaryngology Research Center, Imam Khomeini Medical Complex, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: Mehrdadj82@yahoo.com.
Mehrdad
M
Jafari
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D005206:Fascia Lata / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery*; D008441:Maxillary Neoplasms / Q000601:surgery; D008875:Middle Aged; D009915:Orbit / Q000601:surgery*; D010255:Paranasal Sinus Neoplasms / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D013526:Surgical Mesh; D014025:Titanium; D016896:Treatment Outcome
D014025:Titanium