25 - Midface Reconstruction

Abstract

Reconstruction of maxillary and other midface defects are among the most challenging operations performed by reconstructive surgeons. While a number of classification systems have been described, the most straightforward approach is to consider the palatal defect first, then the orbital floor, followed by the orbital contents. The decision between prosthetic obturation, soft tissue flap reconstruction, and osteocutaneous free flap reconstruction depends on the location of the palatoalveolar defect. Alloplasts and bone grafts are common options for the orbital floor, which does not need to be repaired if the orbital contents are not spared. If an orbital exenteration alone has been performed, a concave orbital cavity can be created that facilitates prosthesis retention, if one is desired, using a thin fasciocutaneous free flap. Otherwise, the orbital cavity is closed with a bulky free flap that is flush with the cheek and forehead, which is also recommended when one or more of the orbital walls has been removed.