OP036: Reconstruciton of bilateral maxillectomy defect

Abstract

Purpose To study the outcome of reconstruction of bilateral maxillectomy defect with free fibula flap in our institute. Materials and methods Eight consecutive cases of bilateral maxillectomy defect reconstruction with free fibula flaps were reviewed. The period of study was from January 2006 to June 2012. All clinical data were analyzed, including primary diseases, types of bilateral maxillectomy defect, flap design, peri operative complications and follow up results. The main post operative functional indices, including oral diet, speech, type of dental restoration and aesthetic results were evaluated. Results Of the eight patients who underwent bilateral maxillectomy, six were having malignant etiologies while two were benign. Four patients were males and four females. Seven of them had bilateral upper alveolus defects while one had a high bilateral defect where the alveolus could be preserved. Free fibula flap was used in all patients. There was one flap failure. Post operatively recipient site wound infection occurred in two patients, one of which cleared with conservative treatment. In the other patient fibula got exposed on one side and had to be covered with free adiposofascial radial artery forearm flap, leading to delay in oral feeding by one month. In all other patients feeding was started orally within two weeks. Adequate oronasal separation, intelligible speech and good cosmesis could be achieved in all patients. All patients opted for conventional prosthesis, though the option of dental implants was available. Conclusion Reconstruction of bilateral maxillectomy defect is challenging. Free fibula is the most effective option for reconstructing this defect at present. Acceptable levels of cosmesis, good swallowing and speech functions with low peri operative morbidity can be achieved by reconstructing this defect using free fibula.