title: Avoiding Facial Incisions with Midface Free Tissue Transfer.
abstract: BACKGROUND
  We have adopted an intraoral microsurgical anastomosis to the facial vessels to eliminate the need for any visible facial incisions.
  
  
  METHODS
  Cadaveric dissection was used to demonstrate accessibility of the facial artery and vein through an intraoral approach. Additionally, 5 patients underwent free tissue transfer for reconstruction of major defects of the midface through an intraoral, transmucosal approach, obviating the need for visible skin incisions.
  
  
  RESULTS
  The pathology included palatal defects due to mucoepidermoid carcinoma and ischemic necrosis from cocaine abuse, maxillary defects secondary to fibrous dysplasia and avascular necrosis from traumatic blast injury, and a residual posttraumatic bony deformity of the zygoma. Reconstructions were performed with a free ulnar forearm flap, a free vastus lateralis muscle flap, a deep circumflex iliac artery myoosseous flap, a free fibula flap, and a deep circumflex iliac artery osseous flap, respectively. The facial artery and vein were used as recipient vessels for microvascular anastomosis for all cases. Mean follow-up was 12.2 months. All free tissue transfers were successful, and each patient had a satisfactory aesthetic outcome with no associated facial scars.
  
  
  CONCLUSIONS
  This technique can be employed during reconstruction of an array of bony or soft-tissue midface deficits with minimal morbidity. This small series effectively demonstrates the varied pathologies and tissue deficiencies that can be successfully reconstructed with free tissue transfer using an entirely intraoral approach to the recipient facial vessels, resulting in no visible scars on the face and an improvement in the overall aesthetic outcome.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center School of Medicine, New Orleans, La.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Medical Institute, Baltimore, Md.; Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, N.Y.; and Division of Plastic Surgery, University of Montreal, Montreal, QC.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Stalder
authors.affiliation: Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center School of Medicine, New Orleans, La.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Medical Institute, Baltimore, Md.; Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, N.Y.; and Division of Plastic Surgery, University of Montreal, Montreal, QC.
authors.forename: Michael
authors.initials: M
authors.lastname: Sosin
authors.affiliation: Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center School of Medicine, New Orleans, La.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Medical Institute, Baltimore, Md.; Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, N.Y.; and Division of Plastic Surgery, University of Montreal, Montreal, QC.
authors.forename: Leo J
authors.initials: LJ
authors.lastname: Urbinelli
authors.affiliation: Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center School of Medicine, New Orleans, La.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Medical Institute, Baltimore, Md.; Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, N.Y.; and Division of Plastic Surgery, University of Montreal, Montreal, QC.
authors.forename: James L
authors.initials: JL
authors.lastname: Mayo
authors.affiliation: Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center School of Medicine, New Orleans, La.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Medical Institute, Baltimore, Md.; Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, N.Y.; and Division of Plastic Surgery, University of Montreal, Montreal, QC.
authors.forename: Amir H
authors.initials: AH
authors.lastname: Dorafshar
authors.affiliation: Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center School of Medicine, New Orleans, La.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Medical Institute, Baltimore, Md.; Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, N.Y.; and Division of Plastic Surgery, University of Montreal, Montreal, QC.
authors.forename: Hugo St
authors.initials: HS
authors.lastname: Hilaire
authors.affiliation: Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center School of Medicine, New Orleans, La.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Medical Institute, Baltimore, Md.; Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, N.Y.; and Division of Plastic Surgery, University of Montreal, Montreal, QC.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Borsuk
authors.affiliation: Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center School of Medicine, New Orleans, La.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Medical Institute, Baltimore, Md.; Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, N.Y.; and Division of Plastic Surgery, University of Montreal, Montreal, QC.
authors.forename: Eduardo D
authors.initials: ED
authors.lastname: Rodriguez