Microsurgical reconstruction of the maxilla: Algorithm and concepts

Area of Science:

• Plastic Surgery
• Oral and Maxillofacial Surgery
• Reconstructive Surgery

Background:

• Free tissue transfer is highlighted as the primary method for three-dimensional (3D) maxillary reconstruction.
• The myosseous free iliac crest flap is emphasized as a preferred option for bone grafting in palate and maxillary arch reconstruction.
• A novel classification system and reconstruction algorithm for maxillectomy defects are proposed.

Purpose of the Study:

• To present free tissue transfers as the gold standard for complex maxillary reconstruction.
• To detail technical modifications for improved outcomes in palate, dental implant, and prosthesis reconstruction.
• To analyze functional and aesthetic results from a 24-year experience with midface reconstructions.

Main Methods:

• Analysis of 57 midface defects in 54 patients over 24 years.
• Classification of maxillary defects into four categories (I-IV).
• Evaluation of functional outcomes (diet, speech, vision) and aesthetic outcomes (patient/surgeon scores).

Main Results:

• 52 free flaps were performed with a 96% survival rate.
• Two patients required sequential flow-through flaps.
• Seven patients received obturator prostheses for soft tissue-retained reconstruction.

Conclusions:

• Microsurgical vascularised osteomyocutaneous free flaps are the gold standard for complex maxillectomy defect reconstruction.
• The proposed algorithm aids flap selection based on the defect's anatomy and function.
• This approach facilitates successful reconstruction and restoration of function and aesthetics.