Reconstruction of High Maxillectomy Defects with the Fibula Osteomyocutaneous Flap in Combination with Titanium Mesh or a Zygomatic Implant
(0) This retrospective review examined the authors patients who underwent reconstruction of high maxillectomy defects with fibula osteomyocutaneous flaps in combination with titanium mesh or a zygomatic implant. Outcome assessments included aesthetic, speech, and masticatory function. Methods: Twenty patients who underwent reconstruction of high maxillectomy defects with fibula osteomyocutaneous flaps in combination with titanium mesh (n= 19) orazygomatic implant (n = 1) were reviewed. The fibula was fashioned to recreate the alveolar ridge and pterygomaxillary buttress, and the skin paddle was applied to restore the palate and nasal airway. The anterior wall of the maxilla and the orbital floor were reconstructed with titanium mesh in 19 patients. In four patients with extensive soft-tissue defects, a radial forearm flap was combined to restore missing soft tissue. Aesthetics, speech, and masticatory function were evaluated postoperatively. Results: Nine patients underwent immediate maxillary reconstruction and 11 patients underwent secondary reconstruction. The overall success rate of 24 flaps was 95.8 percent The exposure rate for titanium mesh and the oronasal fistula rate were both 10.5 percent. The average length of follow-up was 34.7 months. Recurrence occurred in only one patient, who died as a result of the disease. Ten patients received implant-borne prostheses or removable partial dentures. Excellent or good cosmesis and intelligible speech were noted in 19 patients. All patients were ultimately able to tolerate a regular or soft diet. Conclusions: Reconstruction of high maxillectomy defects with the fibula osteomyocutaneous flap in combination with titanium mesh or a zygomatic implant is a feasible and acceptable option with a high success rate, a low complication rate, excellent postoperative cosmesis, and well-accepted function.
Jian Sun Yi Shen Jun Li Zhi-yuan Zhang
Department of Oral and Maxillofacial Surgery, Ninth Peoples Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboralory of Stomatology. Received for publication August 2, 2009, accepted May 19, 2010 Presented in part at the 12th International Congress on Oral Cancer, in Shanghai, China, May 22 through 25, 2008, and at the 90th Annual Meeting of the A merican Association of Oral and Maxillofacial Surgeons, in Seattle, Washington, September 16 through 21, 2008
国际会议
上海
英文
187-197
2011-12-28（万方平台首次上网日期，不代表论文的发表时间）