Medial femoral periosteal microvascular free flap: a new method for maxillary reconstruction.

摘要

Maxillary defects may arise from ablative tumor surgery or severe maxillofacial trauma. Contemporary maxillofacial reconstruction must consider both functional and esthetic concerns to optimize reconstruction, with the ultimate goal of prosthetic dental rehabilitation. Several techniques are available for maxillary reconstruction, including nonvascularized bone grafting from the iliac crest, and an entire gamut of microvascular reconstructive options. The choice of reconstruction should be based on the nature of the defect, and the patient's tolerance for donor-site morbidity. Several microvascular techniques were described for extensive composite maxillary defects: most notably, the free fibula osteocutaneous and deep circumflex iliac artery free flap. Alternative approaches for moderate to large composite maxillary defects include soft tissue-only reconstruction for defect obliteration without bone reconstruction, using myorotational flaps such as the temporopari-etal rotational flap, and free-tissuetransfer with the rectus abdominus or latissimus dorsi muscle. Obliteration of the soft-tissue defect after maxillectomy may isolate the antral and nasal contents for the oropharynx, but renders prosthetic dental rehabilitation difficult, with limited functional outcomes. Some guidelines were presented, as based on phys-ical and anatomic requirements for prosthodontic reconstruction.