Avulsive injuries and ablative surgery for both aggressive benign and malignant disease, even when wellreconstructed, leave anatomy that provides no effective means of stabilizing prosthesis. For such patients, implantstabilized or, preferably, implant-supported restorations have become the ultimate goal. Defects of the entire craniofacial complex, including esthetic and functional problems, can now be addressed much more predictable and completely than ever before.
We present six patients with maxillary and palate defects that were reconstructed with the radial forearm flap. Four patients had malignant neoplasms involving the maxilla, three with squamous cell carcinoma and the fourth with recurrent basal cell carcinoma. They were treated with excision and immediate reconstruction using a radial forearm free flap. The other two patients presented with large fistulae between the maxilla and nasal sinuses, these being sequelae of previous surgical treatment for malignancies. The fistulae were closed with radial forearm free flaps. This method provides primary wound healing, restoration of palatal function, preservation of facial contour, and a minimal morbidity while obviating the need for palatal prosthesis. In the six cases, the oral cavity has been completely separated from the paranasal sinus and nasal cavity, and all patients demonstrated satisfactory deglutition and intelligible speech.
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