Palatal, Maxillary, and Orbital Reconstruction

Abstract

Successful reconstruction of the maxilla or midface requires a thorough understanding of the anatomy, defect dimensions, and flap options. Several classifications of maxillectomy defects exist, with Cordeiro’s and Bronn’s being commonly uses. With the advances of reconstructive techniques, free tissue transfer become more widely used and is able to provide satisfactory results in palatal, maxillary, and orbital reconstruction. Workhorse free flaps include the anterolateral thigh flap, the profunda artery perforator flap, the medial sural artery perforator flap, the radial or ulnar forearm flap, the rectus abdominis myocutaneous flap, the iliac flap, the scapular flap, and the fibula flap. For palatal defect, the goal is to seal the defect and recreate the barrier between the nasal cavity and the oral cavity; a proper selection of flap based on the dimension of the defect and the thickness of the flap is important. For orbitomaxillary or maxillary defect, decisions are commonly made between soft-tissue flaps or bone-containing flaps. Decision is first made whether to provide bony reconstruction or not. In general, bony reconstruction is strongly considered if the infraorbital rim or the premaxilla is involved. Non-vascularized bone can be considered for infraorbital rim reconstruction but not the premaxilla. For vascularized bony reconstruction, the fibula flap is the primary choice.

With adequate knowledge of the basic anatomy, correct perception of defect, and proper selection of reconstructive techniques, a successful reconstruction can be readily achieved.