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Abstract

Reconstruction of the maxilla is a challenge for the maxillofacial and oral surgeon. Defects caused by injury or tumor resection alter the stomatognathic system, leading to cosmetic and functional abnormalities.

Surgery for primary reconstruction of defects resulting from tumor resection is less complicated because no radiation therapy has been administered and fibrosis is not present. Consequently, the patient can return to work and regain a normal social and personal life.

Since there is no ideal surgical technique for reconstruction of the middle third, the type of defect, general status, and experience of the surgical team are key factors.

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References

  1. Smolka W, Iizuka T. Surgical reconstruction of maxilla and midface: clinical outcome and factors relating to postoperative complications. J Craniomaxillofac Surg. 2005;33(1):1–7.

    Article  PubMed  Google Scholar 

  2. Kreeft AM, Krap M, Wismeijer D, Speksnijder CM, Smeele LE, Bosch SD. Oral function after maxillectomy and reconstruction with an obturator. Int J Oral Maxillofac Surg. 2012;41(11):1387–92.

    Article  CAS  PubMed  Google Scholar 

  3. Okay DJ, Genden E, Buchbinder D, Urken M. Prosthodontic guidelines for surgical reconstruction of the maxilla: a classification system of defects. J Prosthet Dent. 2001;86(4):352–63.

    Article  CAS  PubMed  Google Scholar 

  4. Cordeiro PG, Chen CM. A 15-year review of midface reconstruction after total and subtotal maxillectomy: part I. Algorithm and outcomes. Plast Reconstr Surg. 2012;129(1):124–36.

    Article  CAS  PubMed  Google Scholar 

  5. Futran ND, Mendez E. Developments in reconstruction of midface and maxilla. Lancet Oncol. 2006;7(3):249–58.

    Article  PubMed  Google Scholar 

  6. Edgerton Jr MT. Replacement of lining to oral cavity following surgery. Cancer. 1951;4(1):110–9.

    Article  PubMed  Google Scholar 

  7. Navarro Cuellar C. Reconstrucción mandibular: colgajos libres vs colgajos pediculados (PhD thesis). Madrid; 2005

    Google Scholar 

  8. Willemot J, Michel J. Naissance et développement de l’Oto-rhino-laryngologie dans l’histoire de la médicine. Acta Oto-Rhino-Laryngologica. 1981;35:654–70.

    Google Scholar 

  9. Eley KA, Watt-Smith SR. The nasolabial approach: a potential alternative to the lip-splitting incision for maxillectomy. Br J Oral Maxillofac Surg. 2012;50(1):e6–8.

    Article  PubMed  Google Scholar 

  10. Wells MD, Luce EA. Reconstruction of midfacial defects after surgical resection of malignancies. Clin Plast Surg. 1995;22(1):79–89.

    CAS  PubMed  Google Scholar 

  11. Spiro RH, Strong EW, Shah JP. Maxillectomy and its classification. Head Neck. 1997;19(4):309–14.

    Article  CAS  PubMed  Google Scholar 

  12. Davison SP, Sherris DA, Meland NB. An algorithm for maxillectomy defect reconstruction. Laryngoscope. 1998;108(2):215–9.

    Article  CAS  PubMed  Google Scholar 

  13. Cordeiro PG, Santamaria E. A classification system and algorithm for reconstruction of maxillectomy and midfacial defects. Plast Reconstr Surg. 2000;105(7):2331–46; discussion 47–8.

    Article  CAS  PubMed  Google Scholar 

  14. Triana Jr RJ, Uglesic V, Virag M, Varga SG, Knezevic P, Milenovic A, et al. Microvascular free flap reconstructive options in patients with partial and total maxillectomy defects. Arch Facial Plast Surg. 2000;2(2):91–101.

    Article  PubMed  Google Scholar 

  15. Bidra AS, Jacob RF, Taylor TD. Classification of maxillectomy defects: a systematic review and criteria necessary for a universal description. J Prosthet Dent. 2012;107(4):261–70.

    Article  PubMed  Google Scholar 

  16. Brown JS, Rogers SN, McNally DN, Boyle M. A modified classification for the maxillectomy defect. Head Neck. 2000;22(1):17–26.

    Article  CAS  PubMed  Google Scholar 

  17. Brown JS, Shaw RJ. Reconstruction of the maxilla and midface: introducing a new classification. Lancet Oncol. 2010;11(10):1001–8.

    Article  PubMed  Google Scholar 

  18. Poetker DM, Loehrl TA, Toohill RJ. External medial maxillectomy. Oper Tech Otolaryngol-Head Neck Surg. 2010;21(2):107–10.

    Article  Google Scholar 

  19. Pittman AL, Zender CA. Total maxillectomy. Oper Tech Otolaryngol-Head Neck Surg. 2010;21(3):166–70.

    Article  Google Scholar 

  20. Park KT, Kwon HB. The evaluation of the use of a delayed surgical obturator in dentate maxillectomy patients by considering days elapsed prior to commencement of postoperative oral feeding. J Prosthet Dent. 2006;96(6):449–53.

    Article  PubMed  Google Scholar 

  21. Yasuo H, Kohsuke I, Toshinori M, Kenichi S. Closure of oroantral communications using a pedicled buccal fat pad graft. J Oral Maxillofac Surg. 1995;53:771–5.

    Article  Google Scholar 

  22. Wallace JH, Greg A, Russel R, Chambers K. Use of pedicled fat pad graft as an adjunct in the reconstruction of palatal cleft defects. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;80:24–7.

    Article  Google Scholar 

  23. Khouw YLN, Van Der Wal KGH. Bilateral palatal reconstruction using 2 pedicled buccal fat pads in rhinolalea aperta after extensive necrotizing tonsillitis: a case report. J Oral Maxillofac Surg. 2004;62:749–51.

    Article  PubMed  Google Scholar 

  24. Kim Y-K. The use of a pedicled buccal fat pad graft for coverage in primary palatorrhaphy: a case report. J Oral Maxillofac Surg. 2001;59:1499–501.

    Article  CAS  PubMed  Google Scholar 

  25. Matarasso A. Managing the buccal fat pad. Aesthet Surg J. 2006;26:330–6.

    Article  CAS  PubMed  Google Scholar 

  26. Muzaffar AR, Adams Jr WP, Hartog JM, Rohrich RJ, Byrd HS. Maxillary reconstruction: functional and aesthetic considerations. Plast Reconstr Surg. 1999;104(7):2172–83; quiz 84.

    Article  CAS  PubMed  Google Scholar 

  27. Carstens MH, Stofman GM, Hurwitz DJ, Futrell JW, Patterson GT, Sotereanos GC. The buccinator myomucosal island pedicle flap: anatomic study and case report. Plast Reconstr Surg. 1991;88(1):39–50; discussion 1–2.

    Article  CAS  PubMed  Google Scholar 

  28. Zhao Z, Zhang Z, Li Y, Li S, Xiao S, Fan X, et al. The buccinator musculomucosal island flap for partial tongue reconstruction. J Am Coll Surg. 2003;196(5):753–60.

    Article  PubMed  Google Scholar 

  29. Kaplan EN. Soft palate repair by levator muscle reconstruction and a buccal mucosal flap. Plast Reconstr Surg. 1975;56:129.

    Article  CAS  PubMed  Google Scholar 

  30. Maeda K, Ojimi H, Utsugi R, Ando S. A T-shaped musculomucosal buccal flap method for cleft palate surgery. Plast Reconstr Surg. 1987;79(6):888–96.

    Article  CAS  PubMed  Google Scholar 

  31. Bozola AR, Gasques JA, Carriquiry CE, Cardoso de Oliveira M. The buccinator musculomucosal flap: anatomic study and clinical application. Plast Reconstr Surg. 1989;84(2):250–7.

    Article  CAS  PubMed  Google Scholar 

  32. Zhao Z, Li S, Yan Y, Li Y, Yang M, Mu L, et al. New buccinator myomucosal island flap: anatomic study and clinical application. Plast Reconstr Surg. 1999;104(1):55–64.

    Article  CAS  PubMed  Google Scholar 

  33. Golovine SS. Procédé de cloture plastique de l’orbite aprés l’exentération. Arch Ophthalmol. 1898;18:679–80.

    Google Scholar 

  34. Bradley P, Brockbank J. The temporalis muscle flap in oral reconstruction. A cadaveric, animal and clinical study. J Maxillofac Surg. 1981;9(3):139–45.

    Article  CAS  PubMed  Google Scholar 

  35. Cheung LK. Microvascular network of the healing surface over the temporalis flap in maxillary reconstruction. Int J Oral Maxillofac Surg. 1999;28(6):469–74.

    Article  CAS  PubMed  Google Scholar 

  36. Ahmed Djae K, Li Z, Li ZB. Temporalis muscle flap for immediate reconstruction of maxillary defects: review of 39 cases. Int J Oral Maxillofac Surg. 2011;40(7):715–21.

    Article  CAS  PubMed  Google Scholar 

  37. Brown WJ. Extraordinary case of horse bite: the external ear completely bitten off and successfully replaced. Lancet. 1898;1:1533.

    Article  Google Scholar 

  38. Monks GH. The restoration of a lower lid by a new method. N Engl J Med. 1898;139:385.

    Article  Google Scholar 

  39. Roy C, Bandyopadhyay M, Dubey S, Gupta AK. Temporoparietal fascia flap in intra-oral reconstruction without split thickness skin graft cover: a case report. J Indian Med Assoc. 2013;111(12):852, 4.

    PubMed  Google Scholar 

  40. Lam D, Carlson ER. The temporalis muscle flap and temporoparietal fascial flap. Oral Maxillofac Surg Clin North Am. 2014;26(3):359–69.

    Article  PubMed  Google Scholar 

  41. Mokal NJ, Ghalme AN, Kothari DS, Desai M. The use of the temporoparietal fascia flap in various clinical scenarios: a review of 71 cases. Indian J Plast Surg. 2013;46(3):493–501.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Sakellariou A, Salama A. The use of cervicofacial flap in maxillofacial reconstruction. Oral Maxillofac Surg Clin North Am. 2014;26(3):389–400.

    Article  PubMed  Google Scholar 

  43. Shestak KC, Roth AG, Jones NF, Myers EN. The cervicopectoral rotation flap–a valuable technique for facial reconstruction. Br J Plast Surg. 1993;46(5):375–7.

    Article  CAS  PubMed  Google Scholar 

  44. Soler-Presas F, Cuesta-Gil M, Borja-Morant A, Concejo-Cutoli C, Acero-Sanz J, Navarro-Vila C. Midface soft tissue reconstruction with the facio-cervico-pectoral flap. J Craniomaxillofac Surg. 1997;25(1):39–45.

    Article  CAS  PubMed  Google Scholar 

  45. Futran ND. Primary reconstruction of the maxilla following maxillectomy with or without sacrifice of the orbit. J Oral Maxillofac Surg. 2005;63(12):1765–9.

    Article  PubMed  Google Scholar 

  46. Kajikawa A, Ueda K, Katsuragi Y, Hirose T, Asai E. Three-step orbitofacial reconstruction after extended total maxillectomy using free RAM flap and expanded cervicofacial flap with cartilage grafts. J Plast Reconstr Aesthet Surg. 2010;63(10):1608–14.

    Article  PubMed  Google Scholar 

  47. Wei FC, Demirkan F, Chen HC, Chen IH. Double free flaps in reconstruction of extensive composite mandibular defects in head and neck cancer. Plast Reconstr Surg. 1999;103(1):39–47.

    Article  CAS  PubMed  Google Scholar 

  48. Schliephake H. Revascularized tissue transfer for the repair of complex midfacial defects in oncologic patients. J Oral Maxillofac Surg. 2000;58(11):1212–8.

    Article  CAS  PubMed  Google Scholar 

  49. Kokemueller H, Tavassol F, Rucker M, Gellrich NC. Complex midfacial reconstruction: a combined technique of computer-assisted surgery and microvascular tissue transfer. J Oral Maxillofac Surg. 2008;66(11):2398–406.

    Article  PubMed  Google Scholar 

  50. Taylor GL, Miller G, Ham F. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg. 1975;55:533–44.

    Article  CAS  PubMed  Google Scholar 

  51. Gilbert A. Vascularized transfer of the fibular shaft. Int J Microsurg. 1979;1:100.

    Google Scholar 

  52. Chen Z, Yan W. The study and clinical application of the osteocutaneous flap of fibula. Microsurgery. 1983;4:11–6.

    Article  CAS  PubMed  Google Scholar 

  53. Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg. 1989;84(1):71–9.

    Article  CAS  PubMed  Google Scholar 

  54. Wei FC, Seah CS, Tsai YC, Liu SJ, Tsai MS. Fibula osteoseptocutaneous flap for reconstruction of composite mandibular defects. Plast Reconstr Surg. 1994;93(2):294–304; discussion 5–6.

    Article  CAS  PubMed  Google Scholar 

  55. Pototschnig H, Schaff J, Kovacs L, Biemer E, Papadopulos NA. The free osteofasciocutaneous fibula flap: clinical applications and surgical considerations. Injury. 2013;44(3):366–9.

    Article  PubMed  Google Scholar 

  56. Navarro Vila C, Ochandiano Cacioya S, García Marín F. Tratado de Cirugía Oral y Maxilofacial. 2nd ed. Madrid: St. Louis; 2009.

    Google Scholar 

  57. Navarro Cuéllar C, Ochandiano Caicoya S, Riba Garcia F, Lopez de Atalaya FJ, Acero Sanz J, Cuesta Gil M, et al. Rehabilitación implantosoportada en el colgajo libre de peroné. Revista Española de Cirugía Oral y Maxilofacial. 2006;28:263–75.

    Article  Google Scholar 

  58. Yang G, Chen B, Gao Y, et al. Forearm free skin flap transplantation. Natl Med J China. 1981;61:39.

    Google Scholar 

  59. Duflo S, Lief F, Paris J, Giovanni A, Thibeault S, Zanaret M. Microvascular radial forearm fasciocutaneous free flap in hard palate reconstruction. Eur J Surg Oncol. 2005;31(7):784–91.

    Article  CAS  PubMed  Google Scholar 

  60. Taylor GI, Townsend P, Corlett M. Superiority of the deep circumflex iliac vessels as the supply for free groin free flaps: experimental work. Plast Reconstr Surg. 1979;64:595–604.

    Article  CAS  PubMed  Google Scholar 

  61. Ramasastry SS, Granick MS, Futrell JW. Clinical anatomy of the internal oblique muscle. J Reconstr Microsurg. 1986;2(2):117–22.

    Article  CAS  PubMed  Google Scholar 

  62. Baliarsing AS, Kumar VV, Malik NA, B DK. Reconstruction of maxillectomy defects using deep circumflex iliac artery-based composite free flap. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(3):e8–13. doi:10.1016/j.tripleo.2009.10.055.

    Article  PubMed  Google Scholar 

  63. Brown JS, Jones DC, Summerwill A, Rogers SN, Howell RA, Cawood JI, et al. Vascularized iliac crest with internal oblique muscle for immediate reconstruction after maxillectomy. Br J Oral Maxillofac Surg. 2002;40(3):183–90.

    Article  CAS  PubMed  Google Scholar 

  64. Codivilla A. On the means of lengthening in the lower limbs, the muscles, and tissues which are shortened through deformity. Am J Orthop Surg. 1905;2:353–69.

    Google Scholar 

  65. Ilizarov GA, Soybelman LM. Some clinical and experimental data concerning lengthening of lower extremities. Eksp Khir Anesteziol. 1969;14:27.

    CAS  PubMed  Google Scholar 

  66. Niu XG, Zhao YM, Han XX. Multiplanar and combined distraction osteogenesis for three-dimensional and functional reconstruction of unilateral large maxillary defects. Br J Oral Maxillofac Surg. 2009;47(2):106–10.

    Article  PubMed  Google Scholar 

  67. Bengi O, Karacay S, Akin E, Okcu KM, Olmez H, Mermut S. Cephalometric evaluation of patients treated by maxillary anterior segmental distraction: a preliminary report. J Craniomaxillofac Surg. 2007;35(6–7):302–10.

    Article  PubMed  Google Scholar 

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Correspondence to Carlos Navarro Vila MD, DMD, PhD, FEBOMS .

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Navarro Vila, C., López López, A.M., Maza Muela, C., Navarro Cuellar, C. (2015). Maxillary and Middle Face Reconstruction. In: Navarro Vila, C. (eds) Reconstructive Oral and Maxillofacial Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-20487-1_2

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  • DOI: https://doi.org/10.1007/978-3-319-20487-1_2

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