Vascular iliac crest with inner table of the ilium as an option in maxillary reconstruction

Reconstruction of large maxillary defects has been a long-standing challenge to the reconstructive surgeon. Total maxillary reconstruction is desirable but often not possible; ideally, this would provide all the anatomical structural support, function, and esthetics missing because of the defect. A case is presented in which all the criteria for total maxillary reconstruction have been fulfilled. The patient is a 60-year-old man who had wide excision of his maxilla for ameloblastoma, followed by temporal bone flap reconstruction, which failed. He presented to our institution for further evaluation and possible treatment options; these were discussed with the patient and the multidisciplinary team that deals with congenital and acquired deformities in the head and neck area. An iliac crest free flap that included the inner table of the ilium based on the deep circumflex iliac artery was used for the reconstruction. The procedure is described, including restoration of a nasal lining. Osseointegrated implants were used for dental rehabilitation. Ameloblastoma is briefly discussed. The goals of maxillary rehabilitation and obstacles to obtaining those goals are presented. Options available for maxillary reconstruction are discussed, along with some of their advantages and disadvantages, as is the reason why the iliac crest free flap with the inner table of the ilium was chosen. An iliac crest free flap with microvascular anastomosis to facial vessels was used to reconstruct a large maxillary defect. Osseointegrated implants were used to facilitate dental rehabilitation. Our patient has excellent restoration of oronasal function with a satisfactory esthetic result.