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Reconstruction of Extensive Midfacial Defects After Nasal Cavity Cancer Using Three Free Flaps.

Saaya Ishii1, Mutsumi Okazaki1, Yoko Tomioka1

  • 1Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo.

The Journal of Craniofacial Surgery
|February 2, 2026
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This study demonstrates successful reconstruction of extensive midfacial defects using three free flaps. The advanced reconstructive strategy restored both function and appearance, improving quality of life.

Keywords:
Midface reconstructionmultiple free flapsnasal cavity cancer

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Area of Science:

  • Plastic Surgery
  • Head and Neck Surgery
  • Reconstructive Surgery

Background:

  • Extensive midfacial defects present significant reconstructive challenges.
  • Restoring both function and aesthetics is crucial for patient outcomes.
  • Nasal cavity cancer resection can lead to complex midfacial defects.

Purpose of the Study:

  • To present a case study on reconstructing an extensive midfacial defect.
  • To highlight the successful use of a multi-free flap technique.
  • To demonstrate functional and aesthetic restoration after cancer resection.

Main Methods:

  • Utilized three distinct free flaps for reconstruction: thoracodorsal artery perforator flap with scapular bone for hard palate, prefabricated forearm flap with costal cartilage for the external nose, and anterolateral thigh flap for contracture release and contouring.
  • Employed a staged reconstructive strategy tailored to the defect.
  • Integrated dental implant placement for functional restoration.

Main Results:

  • Achieved favorable functional outcomes, enabling oral intake after initial dysphagia.
  • Demonstrated significant aesthetic improvement, correcting midfacial deformity.
  • Facilitated the patient's recovery of social function through successful reconstruction.

Conclusions:

  • A multi-free flap approach is effective for extensive midfacial reconstruction.
  • Careful planning and execution of staged reconstruction yield excellent functional and aesthetic results.
  • Successful midfacial reconstruction significantly enhances patient quality of life and social reintegration.