[Postoperatively function evaluation of bilateral maxillary reconstruction with vascularized free flaps]

To retrospectively analyze clinical cases of bilateral maxillary defect reconstruction using free flaps, and to evaluate the clinical treatment methods and functional outcomes of free flap reconstruction for bilateral maxillary defects.

This study collected clinical cases between January 2000 and June 2024 at the Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology. Data of surgical procedures were collected, including patient age, gender, etiology of the defect, extent and location of the defect, and the type of reconstruction flaps. The defects were categorized according to the Brown classification into vertical and horizontal categories. Postoperative outcomes were evaluated through clinical follow-up visits and telephone interviews, including the condition of dental prosthesis restoration, oral eating status (scored on a scale of 1-4), swallowing function evaluated by water drinking test, and aesthetic outcomes were assessed using the visual analogue scale (VAS). Data were analyzed using SPSS 23.0 software.

A total of 67 patients were included, with 38 males (56.7%) and 29 females (43.3%). The average age was (55.1±1.8) years. A total of 77 free flap transplantations were performed, with the fibula flap being the most commonly used, followed by the anterolateral thigh flap, radial forearm flap, and rectus abdominis myocutaneous flap. 4 free flaps (5.2%) were observed failed. 26 patients (38.8%) completed the entire follow-up, and all of them (100.0%) had satisfactory separation between the oral and nasal cavities and were able to eat orally. One patient (3.8%) wore a removable denture prosthesis postoperatively, while four patients (15.3%) received dental implants placement, and three of them completed implant-supported prosthesis restoration. According to the water drinking test, Seven patients (10.4%) developed swallowing dysfunction after surgery. The mean VAS score was 7.5±2.3. Analysis based on flap type (bone tissue flap/soft tissue flap) showed no statistically significant differences in postoperative eating, swallowing and aesthetic outcomes between the groups.

The fibula flap and the anterolateral thigh flap are currently the most commonly used and reliable free flap options for bilateral maxillary defect functional reconstruction. Predictable clinical outcomes in oronasal closure, eating, swallowing and aesthetic function have been achieved in most patients.