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Systematic review of autologous midface reconstruction methods: subtotal maxillary defects
D Dadjam1, J Acero-Sanz2, R Coopman3
1Faculty of Medicine and Health Sciences, Ghent University, and Department of Oro, and Craniomaxillofacial Surgery, Ghent University Hospital, Ghent, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, and OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.
Reconstructing subtotal midfacial defects requires tailored approaches based on defect extent. Vascularized bone flaps are crucial for bilateral defects, emphasizing functional rehabilitation and prosthodontic planning.
Area of Science:
- Plastic Surgery
- Oral and Maxillofacial Surgery
- Oncology
Background:
- Subtotal midfacial defects, often from cancer surgery, present complex reconstructive challenges.
- These defects significantly impact speech, swallowing, mastication, facial appearance, and psychosocial well-being.
- Standardized reconstruction methods are lacking due to anatomical complexity and varied terminology.
Purpose of the Study:
- To systematically review flap-based autologous reconstruction methods for subtotal midfacial defects (Mommaerts classification A2H2-H5).
- To identify commonly used techniques and assess their suitability based on defect characteristics.
Main Methods:
- Systematic review of 27 clinical studies with patient-level data from PubMed, Embase, and Wiley Library (up to January 2026).
- Assessment of study quality using the MINORS tool.
- Focus on flap-based reconstructions for specific subtotal midfacial defect types.
Main Results:
- Free flaps were primary for A2 defects; pedicled regional flaps were less common.
- Unilateral defects (A2H2-H3) utilized small osteocutaneous or soft tissue flaps, often in staged procedures.
- Bilateral defects (A2H4-H5) consistently required vascularized bone flaps for skeletal support and dental rehabilitation.
- Functional outcomes correlated with defect size; patient-reported outcomes were limited but indicated satisfaction.
Conclusions:
- Subtotal midfacial reconstruction must be individualized based on the defect's horizontal extent.
- Vascularized bone flaps are essential for bilateral defects to restore anatomy and enable dental rehabilitation.
- Functional recovery and long-term prosthodontic planning are critical components of successful reconstruction.