Multidisciplinary Reconstruction of a Palatomaxillary Defect With Nonvascularized Fibula Bone Graft and Distraction Osteogenesis

Abstract

Reconstruction of extensive palatomaxillary defects with oronasal/antral communication represents a challenge to surgeons. Bone-containing microvascular flaps have been suggested as a promising option for rehabilitation of function and esthetics. These types of flaps, however, might be associated with high morbidity. A combination of less complicated treatments might also provide acceptable results while diminishing potential donor site complications. This clinical report presents a bilateral maxillary defect with oronasal communication due to resection of malignant melanoma of the palate. The lost alveolar bone was initially reconstructed with a nonvascularized fibula bone graft. After 6 months, the alveolar segment was subjected to vertical distraction osteogenesis to increase bone height. After a 3-month consolidation period, the patient received 10 dental implants and an implant-supported fixed prosthesis. To preclude graft harvesting morbidity for reconstructing the oronasal fistula, the frame of the prosthesis was designed to include 3 ball attachments on which a palatal obturator, merely covering the palate, could be stabilized. The removable implant-retained obturator restored function perfectly. During the 5-year follow-up, no complication regarding bone graft, the dental implants, and the obturator has been observed.

Alveolar distraction osteogenesis of a fibula free flap in maxillary reconstruction

“…The maxilla is the major structure of the midface, it is essential for esthetic and functions of the midface. It is a tooth-bearing area, a supporting structure for midfacial soft tissues and a separating barrier between oral and sinonasal cavities [6]. Maxillary reconstruction must restore all the bone, skin and mucosal structures.…”

Regenerative Techniques in Oral and Maxillofacial Bone Grafting

“…This is more obvious when an evidence-based decision is made according to all data presented in the literature. Parameters which can describe alveolar bony defects are: • Defect base width and number of residual bony walls surrounding the defect Anterior and posterior parts of the mandible and maxilla have different bone qualities; hence they have different regenerative capacities [7]. The length of the defect affects the degree of vascularization.…”

“…In vertical defects with no sufficient width to accept implants, the augmentation procedure becomes complicated because both dimensions require restoration [8]. It has been suggested that a wide bony defect base has greater capacity for bone regeneration compared to a narrow base defect [7]. The number of surrounding bony walls around the defect is mentioned in the literature as stabilization for the initial blood clot [8].…”

“…In these large defects DO is a better technique to regenerate new bone and reconstruct the defect [34]. Sometimes the combination of microvascularized grafts with DO procedure is an ideal technique to reconstruct large defects especially defects caused by resection of pathologic lesions [7]. DO in transverse dimension is an interesting method being used in patients with arch constriction or an alveolar cleft.…”