• Archives of Plastic Surgery
• /
• v.34 no.4
• /
• pp.448-454
• /
• 2007

Purpose: The objective of this study was to evaluate the outcomes of using the free flap in the reconstruction of maxillary defects. Methods: 27 consecutive cases of maxillary reconstruction with free flap were reviewed. All clinical data were analyzed, including ideal selection of flap, time of reconstruction, recurrence of cancer, postoperative complications, flap design, and follow-up results. The main operative functional items, including speech, oral diet, mastication, eye globe position and function, respiration, and aesthetic results were evaluated. Results: Among the 24 patients who underwent maxillary reconstruction with the free flap, 14 patients underwent immediate reconstruction after maxillary cancer ablation, and 10 patients underwent delayed reconstruction. There occurred 1 flap loss. Recurrences of the cancer after the reconstruction happened in 2 cases. Postoperative complications were 3 cases of gravitational ptosis of the flap, 2 cases of the nasal obstruction, and 1 case of fistula formation. Out of 27 free flaps, there were 15 latissimus dorsi myocutaneous flaps, 5 radial forearm, 4 rectus abdominis myocutaneous flaps, 1 scapular flap, 2 fibula osteocutaneous flap, respectively. Flaps were designed such as 1 lobe in 9 cases, 2 lobes in 9 cases, and 3 lobes in 5 cases. Among the 14 patients who had intraoral defect or who had palatal resection surgery, 2 patients complained the inaccuracy of the pronunciation due to the ptosis of the flap. It was corrected by the reconstruction of the maxillary buttress and hung the sling to the upper direction. All of the 14 patients were able to take unrestricted diets. In 6 patients who had reconstruction of inferior orbital wall with rib bone graft, they preserved normal vision. Aesthetically, most of the patients were satisfied with the result. Conclusion: LD free flap is suggested in uni-maxilla defect as the 1st choice, and fibular osteocutaneous flap and calvarial bone graft to cover the larger defect in bi-maxilla defect.

• The Journal of the Korean dental association
• /
• v.49 no.9
• /
• pp.527-534
• /
• 2011

Microvascular reconstruction of maxillary composite defect after oncologic resection has improved both esthetic and functional aspect of quality of life of the cancer patients. However, a lot of patients had prior surgery with radiation and/or chemotherapy as a part of comprehensive cancer treatment. Sometimes it is nearly impossible to find out adequate recipient vessel for maxillary reconstruction with microvascular anastomosis. Therefore long pedicle of the flap is needed to use distant neck vessels located far from the reconstruction site such as ipsilateral transverse cervical artery or a branch of contralateral external carotid artery. For this reason, although we know the treatment of the choice is osteocutaneous flap, it is difficult to use this flap when we need long pedicle with complex three dimensional osseous defect. Vascular option for these vessel-depleted neck patients can be managed by a soft tissue reconstruction with long vascular pedicle and additional free non-vascularized flap that is rigidly fixed to remaining skeletal structures. For this reason, maxillofacial reconstruction by vascularized soft tissue flap with or without the secondary restoration of maxillary bone with non-vascularized iliac bone can be regarded as one of options for reconstruction of profound maxillofacial composite defect resulted from previous oncological resection with chemo-radiotherapy.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.33 no.1
• /
• pp.44-48
• /
• 2011

Maxillary defects are inherently complex because they generally involve more than one midfacial component. In addition, most maxillary defects are composite in nature, and often require bony support, as well as a mucosal lining for reconstruction. Therefore, midfacial bone and soft tissue defects present a unique challenge because they require a complex arrangement of tissues in a relatively limited space. This might be difficult to achieve only with free osteocutaneous flaps. The use of bone grafts allows greater flexibility in a reconstruction but is limited by graft resorption. We report a case of a patient reconstructed with a lateral arm free flap, iliac bone graft, sagital split ramus osteotomy for the reconstruction of a right maxillary defect zygomatico-maxillary defect caused by a zygomatico-maxillary malignant tumor resection.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.30 no.4
• /
• pp.301-307
• /
• 2004

The flap considered at first for the reconstruction of large maxillary defect, especially mid-face defect, is scapular free flap, because it provides ample composite tissue which can be designed 3-dimensionally for orbital, facial and oral reconstruction. In case of maxillary defect involving hard palate, however, this flap has some limitations. First, its bulk prevents oral function and physio-anatomic reconstruction of nasal and oral cavity. Second, mobility and thickness of cutaneous paddle covering the alveolar area reduce retention of tissue-supported denture and give rise to peri-implantitis when implant is installed. Third, lateral border of scapula that is to reconstruct maxillary arch and hold implants is straight, not U-shaped maxillary arch form. To overcome these problems, new concept of step prefabrication technique was provided to a 27-year-old male patient who had been suffering from a complete hard palate and maxillary alveolar ridge defect. In the first stage, scapular osteomuscular flap was elevated, tailored to fit the maxillary defect, particulated autologous bone was placed subperiosteally to simulate U-shaped alveolar process, and then wrapped up with split thickness skin graft(STSG, 0.3mm thickness). Two months later, thus prefabricated new flap was elevated and microtransferred to the palato-maxillary defect. After 6 months, 10 implant fixtures were installed along the reconstructed maxillary alveolus, with following final prosthetic rehabilitation. The procedure was very successful and patient is enjoying normal rigid diet and speech.

• Korean Journal of Head & Neck Oncology
• /
• v.20 no.1
• /
• pp.41-43
• /
• 2004

An advanced maxillary sinus cancer requires an extensive ablation that results an extensive facial deformity, including a skin defect. Reconstruction has to be considered in a radical maxillectomy, especially with skin defect may be accomplished in one stage with a microsurgical free transfer of a latissimus dorsi flap. A man of right maxillary sinus cancer, squamous cell carcinoma, 47 years old of age, had soft tissue invasion of the cheek region. He underwent a radical maxillectomy with extensive skin excision. The maxillectomy and skin defects were reconstructed with the double skin island latissimus dorsi myocutaneous free flap. The cosmetic result and the functional outcome of the nose were thought to be considerably satisfied.

• Archives of Plastic Surgery
• /
• v.32 no.3
• /
• pp.381-384
• /
• 2005

Rhabdomyosarcoma is a rare malignancy of head and neck region. When rhabdomyosarcoma occurs in maxillary area, total maxillectomy is necessary. Total maxillectomy causes defects of orbital floor, palate, gingiva, and alveolar bone, causing severe facial deformity and functional impairment. Immediate maxillary reconstruction has to cover both bone and soft tissue to minimize cosmetic and functional problems. The fibular osteocutaneous free flap can provide paranasal, gingiva, oral mucosal lining and foundation for dental prosthesis, thus ensuring good cosmetic results and mastication, phonation function. We have experienced a reconstruction case of a 19-year-old man with rhabdomyosarcoma of the left maxillary sinus. The patient underwent total maxillectomy and neck dissection. We designed a fibular free flap that had a vascularized bone segment and a double skin paddle. Surgical outcomes were excellent in cosmetic and functional aspects.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.41
• /
• pp.43.1-43.5
• /
• 2019

Background: Reconstructive surgery is often required for tumors of the oral and maxillofacial region, irrespective of whether they are benign or malignant, the area involved, and the tumor size. Recently, three-dimensional (3D) models are increasingly used in reconstructive surgery. However, these models have rarely been adapted for the fabrication of custom-made reconstruction materials. In this report, we present a case of maxillary reconstruction using a laboratory-engineered, custom-made mesh plate from a 3D model. Case presentation: The patient was a 56-year-old female, who had undergone maxillary resection in 2011 for intraoral squamous cell carcinoma that presented as a swelling of the anterior maxillary gingiva. Five years later, there was no recurrence of the malignant tumor and a maxillary reconstruction was planned. Computed tomography (CT) revealed a large bony defect in the dental-alveolar area of the anterior maxilla. Using the CT data, a 3D model of the maxilla was prepared, and the site of reconstruction determined. A custom-made mesh plate was fabricated using the 3D model (Okada Medical Supply, Tokyo, Japan). We performed the reconstruction using the custom-made titanium mesh plate and the particulate cancellous bone and marrow graft from her iliac bone. We employed the tunneling flap technique without alveolar crest incision, to prevent surgical wound dehiscence, mesh exposure, and alveolar bone loss. Ten months later, three dental implants were inserted in the graft. Before the final crown setting, we performed a gingivoplasty with palate mucosal graft. The patient has expressed total satisfaction with both the functional and esthetic outcomes of the procedure. Conclusion: We have successfully performed a maxillary and dental reconstruction using a custom-made, pre-bent titanium mesh plate.

• The Journal of Advanced Prosthodontics
• /
• v.8 no.1
• /
• pp.70-74
• /
• 2016

In the maxillary anterior region, reconstruction of the localized alveolar ridge defect is very important in enhancing the esthetics of fixed partial denture. A 40-year-old female patient presented with a chief complaint of the inconvenience and unesthetic problem of 3-unit maxillary anterior prosthesis due to alveolar ridge resorption. After removal of old prosthesis, intraoral examination revealed moderate (buccolingually 4 mm) ridge deficiency in missing tooth region, leading to the diagnosis of Class I alveolar ridge defect. One of the reconstruction techniques to overcome this problem might be a technique that combines two types of soft tissue augmentation techniques. The purpose of this paper was to demonstrate the new combined technique of roll flap and combination onlay-interpositional graft utilized to acquire sufficient dimension of recipient area by one time of operation and to present the esthetic improvement of fixed partial denture by using this procedure in case of maxillary anterior localized ridge defect.

• The Journal of the Korean dental association
• /
• v.41 no.8 s.411
• /
• pp.566-571
• /
• 2003

Now a days, immediate implant placement: is becoming one of the popular method. But for the success of this method in implant surgery, initial stability and establishment of sufficient blood supply to the implant placement: areas are very important. Buccal Fat Pad(BFP) has favorable characteristics for the reconstruction of maxillary hard &soft tissue defects. So it has been used for reconstruction of posterior maxillary area or closure of oro-antral area. Using BFP, we could get primary tissue closure without extensive releasing incision during implant surgery and adequate attached gingival after healing of the surgical area. So We report clinical usefulness of BFG during immediate important placement in the posterior maxillary area

• Korean Journal of Bronchoesophagology
• /
• v.6 no.1
• /
• pp.118-126
• /
• 2000

A radical maxillectomy causes a defect of the alveolar bone, gingiva, palate, and orbital floor and causes cosmetical problems and masticatory and phonatory functions. Defect after a radical maxillectomy was reconstructed with skin or dermis graft was introduced, but recently wide resection of the tumor and functional reconstruction with free flap was introduced by several methods. The defect due to radical maxillectomy was reconstructed with scapula, iliac crest, radius. But reconstruction with a fibular osteocutaneous free flap was rarely introduced to defect of radical maxillectomy. The fibular osteocutaneous free flap was firstly introduced by Taylor. The fibular osteocutaneous free flap has several advantages. We experienced the first case of radical maxillectomy and reconstruction with the fibular osteocutaneous free flap, so we reported that case with literatures. The patient has a right maxillary sinus squamous carcinoma (T2N0M0), and performed a radical maxillectomy with right supraomohyoid neck dissection, and reconstruction with fibular osteocutaneous free flap. Donor site morbidity was little, and phonatory and masticatory function were nearly normalized. And cosmetical result was very acceptable.