Use of the Free Fibula Flap for Restoration of Orbital Support and Midfacial Projection Following Maxillectomy

ABSTRACT

A total maxillectomy defect, if left unreconstructed or if poorly reconstructed, can lead to enophthalmos, orbital dystopia, feeding and speech problems, and loss of midfacial projection and vertical facial height. When the eye is preserved, despite resection of the supporting infraorbital bone during maxillectomy, bone reconstruction needs to be considered, using a vascularized bone flap. The authors have used the free fibula flap to simultaneously provide orbital support and restore midfacial projection in three patients, following total maxillectomy without orbital exenteration. For large maxillectomy defects with insufficient bony support, a free fibula flap should be considered as a reconstructive method, to adequately restore contour and the necessary structural support, and to provide optimal aesthetic and functional results.

KEYWORDS

Maxillary reconstruction - maxillectomy - free fibula flap

REFERENCES

• 1 Schusterman M A, Reece G P, Miller M J. Scientific papers. Osseous free flaps for orbit and midface reconstruction.  Am J Surg . 1993;  166 341-345
• 2 Shestak K C, Schusterman M A, Jones N F. Immediate microvascular reconstruction of combined palatal and midfacial defects.  Am J Surg . 1988;  156 252-255
• 3 Yaremchuk M J. Vascularized bone grafts for maxillofacial reconstruction.  Clin Plast Surg . 1989;  16 29-39
• 4 Swartz W M, Banis J C, Newton E D. The osteocutaneous scapular flap for mandibular and maxillary reconstruction.  Plast Reconstr Surg . 1986;  77 530
• 5 Lee H B, Hong J P, Kim K T. Orbital floor and infraorbital rim reconstruction after total maxillectomy using a vascularized calvarial bone flap.  Plast Recontr Surg . 1999;  104 646-653
• 6 Nakayama B, Matsuura H, Hasegawa Y. New reconstruction for total maxillectomy defect with a fibula osteocutaneous free flap.  Br J Plast Surg . 1994;  47 247-249
• 7 Duffy Jr J F, Gan B S, Israeli D. Use of bilateral folded radial forearm free flaps for reconstruction of a midface gunshot wound.  J Reconstr Microsurg . 1998;  14 89-96
• 8 Cordeiro P G, Bacilious N, Schantz S, Spiro R. The radial forearm osteocutaneous “sandwich” free flap for reconstruction of the bilateral subtotal maxillectomy defect.  Ann Plast Surg . 1998;  40 397-402
• 9 Davidson S P, Sherris D A, Meland N B. An algorithm for maxillectomy defect reconstruction.  Laryngoscope . 1998;  108 215-219
• 10 Kazaoka Y, Shinohara A, Kazuhisa Y, Hasegawa T. Functional reconstruction after a total maxillectomy using a fibula osteocutaneous flap with osseointegrated implants.  Plast Reconstr Surg . 1999;  103 1244-1246
• 11 Sadove R C, Powell L A. Simultaneous maxillary and mandibular reconstruction with one free osteocutaneous flap.  Plast Reconstr Surg . 1993;  92 141-146
• 12 Foster R D, Anthony J P, Singer M I. Reconstruction of complex midfacial defects.  Plast Reconstr Surg . 1997;  99 1555-1565