Reconstruction of High Maxillectomy Defects with the Fibula Osteomyocutaneous Flap in Combination with Titanium Mesh or a Zygomatic Implant

Abstract

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. Twenty patients who underwent reconstruction of high maxillectomy defects with fibula osteomyocutaneous flaps in combination with titanium mesh (n = 19) or a zygomatic 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. 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. 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.