Multiunit Defects

Abstract

A discussion of multiunit defect reconstruction of the maxillofacial complex requires an appropriate definition of the term. While there are a number of classification systems which define subdivisions of individuals units such as the lower face or orbitomaxillary complex, for instance [1–5], yet detailed classification of multiunit defects of the face as a whole has not been described. Gonzalez-Ulloa originally provided a system of classifying the esthetic subunits of the face, and Zan et al. provide a more modern classification of cutaneous facial defects based upon the extent of reconstruction [6, 7]. These classifications, while including consideration of subunits of the face, are particularly applicable to surface anatomy. They do not necessarily account for the important three-dimensional and functional aspects that have considerable impact on outcomes in complex post-ablative defects. While the average head and neck surgeon would likely “know it when they see it,” to paraphrase Supreme Court Justice Stewart, a broad definition should include defects that involve more than one anatomic or functional component of the maxillofacial complex. Examples would be a defect involving the skin, mucosa, and bone or mandible plus the maxilla or tongue plus the pharynx. The list of possible combinations is long.