Reconstruction of premaxilla with fibula free flap

The reconstruction of the maxilla after surgical excision of malignant neoplasms has always presented significant difficulties. The excision of the premaxillary region involves considerable aesthetic and functional problems and, thus, presents particular reconstructive difficulties. The difficulties in the reconstruction of this area are related to the advanced anterior position and to the structural complexity of the premaxilla. In addition, soft tissue reconstructions, which might be used potentially to create an oral-nasal diaphragm, are often functionally and aesthetically unsatisfactory. Microvascular options have dramatically improved the reconstructive possibilities. Among free flaps, the fibula, scapula, and iliac crest are most used in the reconstruction of the upper jaw because of their advantageous compositional characteristics and plasticity. In our experience, however, the fibula free flap has emerged as the best reconstructive option for the premaxillary region because of the length of the pedicle, the flexibility and good quality of the bone, the reduced bulk of the soft tissue, and the low potential for problems at the donor site.