Immediate microvascular reconstruction of combined palatal and midfacial defects using soft tissue only

Maxillary and midface defects with or without orbital involvement are disfiguring and disabling problems especially in the elderly cancer patient. Often, palatal prostheses are required to enable speech and swallowing. Elderly patients or those with compromised vision often find these appliances cumbersome and difficult to manage. To help obviate these problems a one-stage method of immediate palatal reconstruction was needed to obturate the palate and restore facial contour. Over the past 18 months six patients have undergone immediate reconstruction of complex, composite defects of the maxillary and midface structures after tumor extirpation, three of which extended into the orbit. The latissimus dorsi musculocutaneous flap was utilized because of its bulk, reliable anatomy, ample pedicle length and diameter, and minimal donor site morbidity. No flap loss, suture line dehiscence, or infection occurred. All patients were capable of deglutition and intelligible speech. This technique is a one-stage reconstruction of the palate and accompanying defects of the midface and maxilla that obviates the need for cumbersome palatal appliances.