Free Flap Reconstruction of the Maxilla

Vincent, Aurora G.; Burkes, Jason N.; Williams, Fayette C.; Ducic, Yadranko

doi:10.1055/s-0039-1677701

Cited by 25 publications

(18 citation statements)

References 24 publications

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“…Many authors agree to recommend closing minor defects primarily. Locoregional flaps such as palatal island flap or buccinator myomucosal island flap have good functional results [7]. However, they have limited applications: they are restricted to small tumours, and they cannot be used in patients with a history of previous oropharyngeal radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…For a long time, prothesis and obturators have been an alternative. It is cheaper than the reconstructive option and allows easier clinical monitoring for cancer recurrence [7]. However, it is difficult to make an obturator that ensures perfect sealing.…”

Section: Discussionmentioning

confidence: 99%

“…This flap brings a large skin paddle and a solid bone for further dental implantation. Radial osteocutaneous forearm free flap is also commonly used, with the advantage of a more mobile skin paddle but a more fragile bone [7].…”

Section: Discussionmentioning

confidence: 99%

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Free flap for soft palate reconstruction: long-term functional evaluation of a new technique

Colliard

Pincet

Simon

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose The soft palate (SP) has a complex anatomy and physiology. Reconstruction after tumour resection is a challenge, and procedures that only restore bulk don’t give good results. We aim to present a new technique for the in-setting and the functional outcomes. Methods We retrospectively included in a monocentric retrospective cohort study every patient with a first diagnosis of a soft palate squamous cell carcinoma (SPSCC), who underwent a tumoral resection with a free flap reconstruction, from February 2013 to July 2017. For the in-setting, a special care is given for the flap in-setting: we suture the flap more caudally than usual under the tongue base, creating a neo-posterior pilar. The primary outcome was the deglutition function, assessed by the M. D Anderson Dysphagia Inventory (MDADI). We also analyzed the patient’s quality of life with the FOSS score and the occurrence of nasal regurgitation or larynx aspiration. Results We included twenty patients, with a median follow-up of 26.5 months. The median MDADI score was 89, and the mode was 93. A Fisher test shows a significant improvement of MDADI scores for unilateral vs bilateral reconstructions (p = 0.03). The median FOSS score was 2, and the mode was 2. Seven (35%) patients complained of nasal regurgitation, three (15%) reported episodic laryngeal aspiration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Free flap for soft palate reconstruction: long-term functional evaluation of a new technique

Colliard

Pincet

Simon

et al. 2021

Eur Arch Otorhinolaryngol

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“…With the incorporation of free flaps reconstruction becomes a feasible single stage procedure without limitations on tissue volume and orientation, vessel geometry and vascular pedicled length (19).…”

Section: The Reconstructive Laddermentioning

confidence: 99%

Reconstruction of midfacial defects

Lago-Beack¹,

Acero²

2021

Front Oral Maxillofac Med

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Defects of the maxilla and midfacial structures following trauma, benignant or malignant tumor ablation are a challenge for the reconstructive surgeon because of the importance of physical appearance and speech, swallowing and visual functions in which this anatomical area is involved. The bony and soft tissues constituting the midface provide much of the facial contour and profile giving each person its personal appearance. The aim of this paper is to review the methods of reconstruction after oncological resection of the middle third of the face and to present our reconstructive protocol. Reconstructive methods available to restore the defect after oncologic resection in this area can include: (I) obturators; (II) local or regional pedicled flaps; (III) microvascular flaps (forearm, rectus abdominis, fibula, iliac crest, scapula flap, etc.).Repair of a midfacial defect should be based on the size, location and type of tissues involved. It is important to understand the complex three-dimensional anatomy of the maxilla so as the interrelation to adjacent structures of the midface prior to approach the decision-making plan. Indications and disadvantages of the different techniques are reviewed. New technological developments including virtual planning, 3D printing and navigation can contribute to increase safety and accuracy in oncologic resection and reconstruction of the midface.

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“…Soft tissue or osteocutaneous free flaps are excellent reconstructive options that have benefits compared to obturation in many cases. [1][2][3][4][5][6][7][8][9] One challenging aspect of using free flaps in the upper and midfacial region is management of the vascular pedicle. In oral cavity or laryngeal free flap reconstruction, common recipient vessels for anastomosis such as the facial artery and vein are adjacent to the site of ablation.…”

Section: Introductionmentioning

confidence: 99%

Technical Considerations in Pedicle Management in Upper and Midfacial Free Flap Reconstruction

et al. 2021

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Objectives: Mid and upper face free flaps frequently are associated with challenges due to pedicle length. We sought to evaluate the frequency at which alternative pedicle maneuvers were required for these reconstructions and determine if there was any association with flap survival or postoperative complications.Study Design: Retrospective review at three tertiary care institutions. Methods: Database review.Results: Free flap reconstruction of the upper and midface was performed in 295 patients (108 bony, 187 soft tissue). In 82% of cases, the vessels reached the ipsilateral neck for anastomosis to traditional target vessels. Arterial grafts were required in 2% of reconstructions (4% bony and 1% soft tissue). Venous grafting was required in 7% of reconstructions (21% fibula, 16% scapula, and 3% soft tissue) and was associated with an increase in flap failure rate (19% vs 3%, P = .003). The most common recipient artery for revascularization was the cervical facial artery (78%). Alternate recipient vessels were selected in 13% of cases, including the superficial temporal vessels (7%), distal facial branches through a separate facial incision (4%), and angular vessels (2%). Vein grafting was associated with a higher flap failure rate. Alternative maneuvers did not affect need for intraoperative pedicle revision or complications.Conclusions: In upper and midface reconstruction, vascular grafting, targeting more distal branches of the facial system, or additional maneuvers to optimize pedicle orientation is often required to secure revascularization. Vein grafting is associated with a higher free flap failure rate. Scapular border flaps often require vascular grafting or atypical anastomotic locations.

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Free Flap Reconstruction of the Maxilla

Cited by 25 publications

References 24 publications

Free flap for soft palate reconstruction: long-term functional evaluation of a new technique

Free flap for soft palate reconstruction: long-term functional evaluation of a new technique

Reconstruction of midfacial defects

Technical Considerations in Pedicle Management in Upper and Midfacial Free Flap Reconstruction

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