State-of-the-art reconstruction of midface and facial deformities

Abstract

Oncologic resection involving the midface results in potentially disfiguring and challenging defects for the reconstructive surgeon. As with any defect, restoration of form and function is critical, but is particularly difficult in the midface, which is paramount to a patient's physical appearance and identify, as well as the patient's ability to breath, speak, see, and eat. Here, we present an algorithmic approach for optimizing outcomes in midfacial reconstruction utilizing the state-of-the-art reconstructive techniques. J. Surg. Oncol. 2016;113:962-970. © 2016 Wiley Periodicals, Inc.

Optimizing the decellularization process of human maxillofacial muscles for facial reconstruction using a detergent‐only approach

“…Facial reconstruction following burns, trauma, and cancer resection is a challenge for reconstructive surgeons due to the complex tissue restoration required (Ng et al, 2017;Chang & Hanasono, 2016;Cavalcante Pita Neto et al, 2018). Skin, cartilage, and bone can be harvested from elsewhere in the body with good outcomes for facial reconstruction (Hahn, 2017).…”

Designing a Fibular Flow-Through Flap with a Proximal Peroneal Perforator-Free Flap for Maxillary Reconstruction

“… 4 , 5 These vascularized bone flaps provide coverage for composite defects in cases where local tissue transfer techniques, such as the facial artery musculomucosal flap, are insufficient in the setting of large palatoalveolar defects with the need for osseointegrated implants. 1 , 2 For patients with a history of a bilateral cleft and palate who present with loss of the premaxilla and palatal fistula, a fibular flap in combination with LeFort I advancement offers the potential of improved occlusion, midface advancement, dental implants, and separation of the oral and nasal cavities. 1 , 2 , 8 Santamaria et al 9 have advocated prelaminating the fibula with buccal mucosa to reduce the need for debulking of a skin paddle.…”

“… 1 , 2 For patients with a history of a bilateral cleft and palate who present with loss of the premaxilla and palatal fistula, a fibular flap in combination with LeFort I advancement offers the potential of improved occlusion, midface advancement, dental implants, and separation of the oral and nasal cavities. 1 , 2 , 8 Santamaria et al 9 have advocated prelaminating the fibula with buccal mucosa to reduce the need for debulking of a skin paddle. However, for patients with a large anterior palatal fistula (ie, extending more posteriorly than the width of the fibula), an osteocutaneous fibular-free flap provides a reliable method to seal the palatal fistula.…”

“…Reconstruction of composite maxillary defects is frequently performed with a fibular osteocutaneous flap to address both the bony and mucosal defects. 1 – 4 Harvesting a fibular flap with a skin paddle based on a distal septocutaneous perforator (ie, in the middle to distal-third of the leg) typically provides enough pedicle length to reach cervical recipient vessels. 2 If during harvest of the fibula, a distal skin perforator is absent, reconstruction can potentially be done using the soleus muscle to fill the mucosal defect (with or without skin grafting) or by harvesting a second independent skin flap using a second set of recipient neck vessels.…”

Soft tissue reconstruction with anterior pedicled inferior turbinate flap in conjunction with palatal flap for standard inferior maxillectomy with hard palate resection

“…Either way, free flaps with microvascular anastomosis are the mainstream treatment option. 2,3 A local hard palate flap, called a palatal island flap, has been used to treat hard palate defects after removal of hard palate tumors. 4 It is based on the greater palatine vessels and can be rotated by 90 and up to 180 to cover defects of the hard palate, soft palate, tonsillar fossa, and retromolar trigone.…”