Reconstruction of the Maxilla with Loss of the Orbital Floor and Orbital Preservation: A Case for the Iliac Crest with Internal Oblique

Abstract

Although many techniques have been described to reconstruct the midface and the maxilla, there remains little agreement on the most effective methods when the orbit itself is preserved but there is loss of the maxilla, orbital floor, and often the medial wall. If the principle of replacing form and function is to be preserved, then a complex three-dimensional bony shape is required, which can support the orbital floor and provide a functioning dentition through an implant-retained prosthesis. At the same time, the oral fistula must be closed and a nasal lining provided. The iliac crest with internal oblique provides a bone structure that can be shaped for the defect and can easily articulate with the malar remnant, the nasal bones, and the upper alveolus. The internal oblique muscle effectively closes the oral fistula and lines the nasal cavity and becomes epithelialized resulting in a natural appearance. This article describes the principles of use of the iliac crest with internal oblique in the reconstruction of this defect and compares this technique with the many other methods reported in the literature. The article is mainly descriptive as there are few comparative studies comparing reconstructive techniques for a similar defect.