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Outcomes of Free Flap Bony Reconstruction for Maxillary Defects: A Systematic Review and Meta-Analysis
Andrea Costantino1, Jack Hyler2, Uthman Alamoudi1
1Department of Otolaryngology - Head and Neck Surgery, AdventHealth Orlando, Orlando, Florida, USA.
The Laryngoscope
|July 30, 2025
Summary
Free flap bony reconstruction effectively restores maxillary defects, yielding high success rates, good speech, and diet function. Dental implant outcomes require further optimization for improved patient results.
Area of Science:
- Oral and Maxillofacial Surgery
- Plastic and Reconstructive Surgery
- Head and Neck Surgery
Background:
- Maxillary defects often result from cancer resection or trauma, necessitating complex reconstruction.
- Free flap bony reconstruction offers a viable solution for restoring form and function.
Purpose of the Study:
- To systematically analyze clinical outcomes of free flap bony reconstruction for maxillary defects.
- To evaluate flap success, fistula rates, speech intelligibility, diet, and dental implant success.
Main Methods:
- A systematic literature search was conducted across PubMed, Scopus, and Google Scholar.
- A single-arm meta-analysis of proportions was performed to determine pooled effect sizes and confidence intervals.
Main Results:
- 837 patients received reconstructions using scapula, fibula, iliac crest, or radial forearm flaps.
- Pooled flap success was 93.0%, with low fistula rates (15.9%) and high speech intelligibility (91.2%).
- Unrestricted diet rates were 81.2%, but pooled dental implant rates were only 23.5%, with variations among flap types.
Conclusions:
- Free flap bony reconstruction is reliable for maxillary defects, ensuring good speech and low fistula rates.
- While functional outcomes like diet are encouraging, dental implant success rates indicate a need for improvement.
- Further research should focus on optimizing conditions for dental implant integration in reconstructed maxillae.
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