Maxillary Reconstruction with Free Vascularized Fibula: 15-Year Experience.

Abstract

Background: Reconstruction of the midface after maxillectomy is extremely challenging because of the need to reestablish the contour of the midface, maintain oronasal separation, support the orbit, and to restore the dentition. In this study, the authors present their specific technique, surgical and functional outcomes, and pitfalls to avoid for reconstruction of the midface with the fibula osteocutaneous free flap.

Methods: A retrospective review of patients who underwent maxillary reconstruction with a fibula osteocutaneous free flap was performed.

Results: Eighty-five flaps were performed in 73 patients (61 patients received a fibula flap only; 12 patients received an additional soft-tissue free flap). Reconstructions were performed for Cordeiro type 2 (82.2%) and Cordeiro type 3a (18.8%) defects. Osseointegrated dental implants were placed in 95.9% of patients, 13.7% of whom underwent immediate implant placement. Concurrent orbital floor reconstruction was performed in 16.2% of patients. The rate of operative take-back was 18.9%, and total flap loss occurred in 2.7%. Hardware exposure occurred in 11.0% at a mean of 4.4 years postoperatively and palatal fistulas occurred in 5.5%, usually within the first 3 weeks following reconstruction. Functionally, 79.5% demonstrated excellent speech and 80.9% had unrestricted diet postoperatively. The mean follow-up period was 3.4 years.

Conclusions: The present study shows that maxillary reconstruction with free fibula flap provides reliable reconstruction that restores dental, orbital, and midfacial support. Modifications and nuances to the reconstructive technique learned over time to avoid complications and improve outcomes are described herein.

Clinical question/level of evidence: Therapeutic, IV.