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Journal of the Korean Society of Plastic and Reconstructive Surgeons 2010;37(5):607-612.
Published online September 1, 2010.
Reconstruction of Midfacial Defects with Free Flaps after Maxillectomy.
Kyul Hee Kim, Chul Hoon Chung, Yong Joon Chang, Young Soo Rho
1Department of Plastic and Reconstructive Surgery, College of Medicine, Hallym University, Seoul, Korea. c21ps@hanmail.net
2Department of Otolaryngology-Head & Neck Surgery, College of Medicine, Hallym University, Seoul, Korea.
Abstract
PURPOSE
Maxillectomy for malignant tumor resection often leads to functional and aesthetic sequalae. Reconstruction following maxillectomy has been a challenging problem in the field of head and neck cancer surgery. In this article, we described three dimensional midface reconstructions using free flaps and their functional and aesthetic outcomes. METHODS: We reconstructed 35 cases of maxillectomy defects using 9 radial forearm free flaps, 7 lattisimus dorsi musculocutaneous free flaps, 6 rectus abdominis musculocutaneous free flaps, 4 fibular osteocutaneous free flaps, and 9 anterolateral thigh free flaps, respectively. We classified post-maxillectomy defects by Brown's classification.1 Articulation clarity was measured with picture consonant articulation test. Swallowing function was evaluated with the University of Washington quality-of-life Head and Neck questionnaire by 4 steps. Aesthetic outcomes were checked to compare preoperative with postoperative full face photographs by 5 medical doctors who did not involve in our operation.
RESULTS
The average articulation clarity was 92.4% (100-41.9%). 27 (81.9%) patients were able to eat an unrestricted diet. Aesthetic results were considered excellent in 18 patients (51.4%). Functional results were best in the group reconstructed with fibular osteocutaneous free flap. Considering the range of wide excision, aesthetic results is best in the group reconstructed with anterolateral thigh free flap.
CONCLUSION
The free flap is a useful technique for the reconstruction of the midface leading to good results, both functionally and aesthetically. Especially, because osteocutaneous flap such as fibular osteocutaneous free flap offered bone source for osteointegrated implant, It produces the best functional results. And perforator flap like as anterolateral thigh free flap reliably provides the best aesthetic results, because it provides sufficient volume and has no postoperative volume diminution.
Keywords: Postmaxillectomy deformity; Midface; Free flap; Reconstruction
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