Comprehensive approach to functional palatomaxillary reconstruction using regional and free tissue transfer: Report of reconstructive and prosthodontic outcomes of 140 patients

Abstract

Palatomaxillary reconstruction applying a systematic approach, using a multitude of techniques, is a safe and effective way to restore patients without compromising the ability to maintain surveillance. Prosthodontic rehabilitation can be achieved in a high percentage of patients using dental implants, leading to optimal aesthetic and functional results.

Reconstructive and prosthodontic outcomes after multiple palatomaxillary reconstructions

“…Approval of this study was obtained through the institutional review board at Mount Sinai Beth Israel Medical Center. Among the 140 patients described in our original series, the patients who required further reconstructive surgery after the initial operation are analyzed in greater detail in this present study. Reconstruction is defined as a major free or locoregional flap operation, excluding flap de‐bulking and other minor procedures.…”

“…Palatomaxillary defects were classified according to the modified classification system by Okay et al, which is based on the biomechanical principles of prosthetic rehabilitation . Briefly, class 1 defects preserve at least three of the four pillars of prosthodontic retention, defined by the bilateral canine and molar teeth.…”

“…Our group reported our comprehensive approach to palatomaxillary reconstruction using a variety of regional and free tissue transfers. We analyzed a series of 140 cases in which there was a 96% flap success rate . Over half of these patients achieved successful prosthodontic rehabilitation.…”

Palatomaxillary Reconstruction: Fibula or Scapula

“…The goals of palatomaxillary reconstruction include projection of the midface, restoration of facial skeleton buttresses, recreation of the palate to permit functional mastication, and separation of oral and nasal passages. 2,8,25 It is important for the reconstructive surgeon to take a goal-oriented approach when counseling patients prior to surgery. As the role of free tissue transfer has expanded, it must not be forgotten that the prosthetic obturator is still the standard to which these reconstructions are measured against.…”

Combined mandibular and maxillary reconstruction: Managing sinus secretions and preventing infection

“…Combined resection of the mandible and maxilla is necessitated by advanced tumors involving both structures . In these cases, the mandible is usually reconstructed with vascularized bone, whereas the maxilla can be restored with soft tissue alone in cases of limited palatal defects.…”