Reconstruction Of Midfacial Defects Research Articles

Reconstruction of Midface Defects after Radical Tumor Resection - a Rare Case Report of Solitary Fibrous Tumour of the Hard Palate.

Introduction- Spindle cell neoplasm is a variant of squamous cell carcinoma. One of its subtypes is solitary fibrous tumor. Its occurrence in head and neck is very rare and rarer in hard palate. But if occurs, radical excision is the only choice as it has malignant potential but coverage of such large mid face defects imposes a challenge in front of a Plastic Surgeon as it demands both soft tissue coverage and skeletal support. Report of the case- A 33 year male presented to our department with swelling of left side face involving the anterior palate, maxilla, nose, and upper lip. With the help of the surgical oncology team, wide local excision of the neoplasm along with bilateral infrastructure maxillectomy, total rhinectomy, total upper lip resection and total hard palatectomy was done. This created large defect in the mid face which was covered with free anterolateral thigh flap. Biopsy was done which revealed the swelling as a solitary fibrous tumor of hard palate. All the margins were free of tumour. The flap settled well. Nostrils were secured with nasal stents. After 3 months, an expander was placed in forehead of the patient for future nasal reconstruction. After 3 months, nasal reconstruction was done using expanded forehead flap and costal cartilage. After 21 days flap detachment and insetting was done. White roll creation was also done. One more secondary procedure was done for flap thinning as patient had complain of nasal obstruction. After 6 months vascularised free fibula bone graft was introduced to reconstruct maxilla for future dental rehabilitation. The patient is in regular follow up and he is satisfied with the results. Discussion- Mid face defects involving perioral and nasomaxillar areas are very uncommon and require composite reconstruction. In such cases, microvascular free flap coverage is an irreplaceable option. Multiple stages might have to be done for further refinement. Conclusion- Reconstruction after oncological resection is always very demanding. With proper preoperative planning and skilled execution, the patient can be benefited functionally, aesthetically and psychosocially.

Reconstruction of Midfacial Defect With Radial Forearm Free Flap

For head and neck reconstruction, especially for reconstruction of midfacial structure, we should consider cosmetic results, functional preservation, and survival of flap. Methods of reconstruction vary from skin graft to free flap. Among those, the radial forearm free flap (RFFF) can be a valuable alternative for defects of midfacial structures such as the eyelid, nose and lip because of its sufficiently long pedicles, lack of bulk and flexibility, all of which enable surgeons to shape the flap into the way they want, and also functionally complement it by using adjacent structures like the palmaris longus muscle tendon. Herein, we introduce various methods of employing RFFF with or without the palmaris longus tendon to get better aesthetic and functional outcomes in reconstruction of midfacial structure.

The Role of Full-Thickness Skin Grafts in Patient's Rehabilitation after Maxillectomy and Midface Defects.

(1) Background: Nowadays, microvascular grafts are the gold standard in the reconstruction of midface defects after maxillectomy, however, not all patients may qualify for this type of surgery. The purpose of present study is to evaluate the benefits of alternative reconstruction methods such as full-thickness skin grafts for these conditions. (2) Methods: The research group consisted of 37 patients who underwent maxillectomy due to cancer of the mid-face and had full-thickness skin graft reconstruction. The study covered the period from 2011 to 2020. (3) Results: Based on the clinical examination and the subjective assessment of patients, a positive effect of the use of free skin grafts on their convalescence and rehabilitation was found. In particular, they contributed to the reduction in postoperative pain and pain associated with prosthetic stages (VAS Scale). (4) Conclusion: Full-thickness skin grafts in combination with individual prosthetic restorations are a good alternative to rehabilitation in patients who do not qualify for microsurgical treatment.

Reconstruction of midfacial defects

: Defects of the maxilla and midfacial structures following trauma, benignant or malignant tumor ablation are a challenge for the reconstructive surgeon because of the importance of physical appearance and speech, swallowing and visual functions in which this anatomical area is involved. The bony and soft tissues constituting the midface provide much of the facial contour and profile giving each person its personal appearance. The aim of this paper is to review the methods of reconstruction after oncological resection of the middle third of the face and to present our reconstructive protocol. Reconstructive methods available to restore the defect after oncologic resection in this area can include: (I) obturators; (II) local or regional pedicled flaps; (III) microvascular flaps (forearm, rectus abdominis, fibula, iliac crest, scapula flap, etc.). Repair of a midfacial defect should be based on the size, location and type of tissues involved. It is important to understand the complex three-dimensional anatomy of the maxilla so as the interrelation to adjacent structures of the midface prior to approach the decision-making plan. Indications and disadvantages of the different techniques are reviewed. New technological developments including virtual planning, 3D printing and navigation can contribute to increase safety and accuracy in oncologic resection and reconstruction of the midface.

Reconstruction of midface defect with temporalis myofascial pedicle flap: a review and case series

Reconstruction of midface defect with temporalis myofascial pedicle flap: a review and case series

Role of Glabellar flap in midfacial reconstruction.

Aims: Reconstruction of midface always poses a challenge to a Plastic surgeon as one has to address the convexities and concavities which are somewhat unique to this area. Various local flaps have been used for achieving these goals. This study was conducted to evaluate the indications, feasibility and outcome of midfacial reconstruction using Glabellar flaps at a tertiary care center.
 Materials and Methods: This is a prospective observational study conducted in the Department of Plastic and Reconstructive Surgery of a tertiary care hospital between January 2016 to December 2019. All the patients who underwent midfacial reconstruction with Glabellar flaps during this period and consented to be a part of this study were included. Patient demographics, wound etiology and area, flap size and its mode of transfer, number of surgeries required, type of anesthesia used, comorbid conditions, complications if any and the results of reconstruction were recorded. All the patients were followed up till May 2020.
 Results: Thirteen patients were managed with Glabellar flaps. Majority of the patients (n=9, 69.23%) were males, with a mean age of 34 years. Most common cause of wounds was animal bite/maul (n=5, 38.46%). Glabellar flap was most commonly used as V-Y rotation advancement flap in nine patients (69.23%). Most of the cases (n=9, 69.23%) was operated under local anesthesia. Donor site was closed primarily in V-Y or linear fashion in 12 cases, and skin grafted only in 1 case. Majority (n=12, 92.3%) of the patients graded reconstruction results as Good-Excellent.
 Conclusions: Glabellar flap is an excellent option for reconstruction of midfacial defects with minimal donor site morbidity and can be performed safely under local anesthesia.

Chimeric temporopareital osteofascial and temporalis muscle flap; a novel method for the reconstruction of composite orbito-maxillary defects

Reconstruction of midface defects are extremely challenging owing to the lack of suitable vascularized local flaps. The temporoparietal fascia and temporalis muscle flaps make excellent choices for midface and orbito-maxillary reconstruction. The muscle provides adequate thickness while the fascia yields pliable soft tissues for lining the midface. The temporalis muscle can be divided antero-posteriorly in three parts and medio-laterally in two parts without losing its vascularity due to its segmental vascular supply. These versatile flaps can be used independently, combined or as chimeric flap based on its axial blood supply for the reconstruction of midface. When designed as a chimeric flap it makes an excellent choice for the reconstruction of composite midface defects. With the advent of micro vascular reconstruction these regional flaps are rarely used in maxillofacial reconstruction. We hereby present a case of composite orbito-maxillary defect reconstruction using a novel chimeric reverse temporalis muscle and temperopareital fascia flap with pedicled split calvarial bone.

Frontal axial pattern flap combined with hard palate mucosa transplant in the reconstruction of midfacial defects after the excision of huge basal cell carcinoma

BackgroundOur article describes our experience with using a frontal axial pattern flap combined with hard palate mucosa transplant to reconstruct midfacial defects after the excision of huge basal cell carcinoma.MethodsWe retrospectively reviewed four patients diagnosed with midface huge basal cell carcinoma through biopsy between 2014 and 2016. Both the eyelid and nose were involved in all the patients. All the patients underwent the studied surgical method and were followed up from 12 to 36 months.ResultsAll the patients preserved good eyelid function and relatively good esthetic satisfaction. No basal cell carcinoma recurred.ConclusionsThis combined surgical procedure is a good method for reconstructing defects after the excision of huge basal cell carcinomas in the midface.

Reconstruction of midface defects with the osteocutaneous radial forearm flap: Evaluation of long term outcomes including patient reported quality of life.

Maxillectomy defects significantly impair quality of life. Prosthetics can overcome some of these issues, but has limitations. The role of the osteocutaneous radial forearm free flap (OC-RFFF) has been established for reconstruction of smaller maxillectomy defects, but its role in larger defects is not well defined. We aim to evaluate outcomes after midface reconstruction utilizing the OC-RFFF. Retrospective review of prospective database collected between 2005 and 2014 of midface reconstruction using OC-RFFF in a tertiary care centre. Donor site complications and acute and long-term recipient site complications were measured. Health related quality of life was assessed using the University of Washington Quality of Life (UW-QOL) Questionnaire. A total of 68 midface defects were reconstructed using the OC-RFFF. Acute recipient site complications included three flap failures (4%), and two additional microvascular revision cases for vascular compromise. Late recipient complications included fistula (n = 10, 14%), ectropion (n = 7, 10%), diplopia (n = 6, 9%) and exposed hardware (n = 5, 7%). Resection of cheek skin or orbital rim correlated with orbital complications. The incidence of fistula was not affected by defect size or prior radiation. There were two donor site infections and no instances of forearm fracture. Patients undergoing OC-RFFF repair had mean scores for UW-QOL outcomes higher than published rates of obturator quality of life. The OC-RFFF is suited to a variety of midface defects and can be combined with hardware to reconstruct the orbital floor. Recipient site complications are common, but donor site morbidity is low and outcomes, including HR-QOL, are acceptable.

Reconstruction of Mid-facial Defects Using Facial Prostheses Supported by Dental Implants

Malignant tumors which affect nasal structures are uncommon. They represent about 0.2% of all cancers and are more than twice as prevalent in males. Squamous cell carcinoma is the most common type of nasal cancer. However, basal cell carcinoma, melanoma, sarcoma and inverting papilloma can involve nose and/or para-nasal sinuses too. Although rare, these pathologies are the most frequent cause for acquired defects of the nose. In this light, the need to obtain clear resection margins obliges surgeon to perform extensive nose amputations. This report describes the case of a 63 years old man affected by squamous cell carcinoma of the nose. A total nose amputation was carried out due to the extension of the tumor. Nasal reconstruction was performed with an implant-retained prosthesis. Three dental implants were used for anchoring the nasal prostheses. This technology is safe and it ensures optimum esthetic results.

Immediate Reconstruction of Midfacial Defects with Osteofascial and Osteocutaneous Free Flaps following Oncological Anterior Skull Base Surgery

Background: Free tissue transfer is commonly used in head and neck reconstruction to restore both form and function following tumor excision. Although, the use of vascularized bone is widely reported in mandibular reconstruction, there is a paucity of literature on the use of osteocutaneous or osteofascial free flaps in facial reconstruction. Free tissue transfer offers both theoretical and practical advantages despite the morbidity associated with increased operative time and potential flap failure. Methods: Retrospective review of a prospectively collected head and neck reconstruction database. Subsequent case note review. Results: We describe the clinical presentation, reconstructive options, and clinical course of five patients who each underwent free flap reconstruction of an anterior skull base defect using bony tissue to replicate midfacial structures. Two patients had nasal bone reconstruction using osteofascial radial forearm free flap reconstruction. Three patients required osteofascial and osteocutaneous fibula and radial forearm free flaps to reconstruct a combination of nasal and malar defects involving the zygoma, maxilla, and mandibular ramus. There was no flap failure. Conclusions: The transfer of vascularized bony tissue in anterior skull base reconstruction is both safe and practical; “like for like” tissue reconstruction may provide superior cosmetic and functional outcomes.

ALTERNATIVAS RECONSTRUCTIVAS POST MAXILECTOMÍA POR ENFERMEDAD NEOPLÁSICA

Reconstructive alternatives post maxillectomy for oncologic disease Background: The reconstruction of midfacial defects is a major challenge. The maxillary bones are the more important of the facial skeleton, provide support between skull base and maxillary arches, separate cavities and are involved in swallowing, phonation, mastication, vision and appearance. The maxillectomy involves varying degrees of functional impairment. The maxillary reconstruction ranges from the use of obturator prosthesis, local flaps to free flaps. Aim: To present the different reconstructive alternatives used after a maxillectomy for oncologic disease in our hospital. Patients and Methods: Retrospective analysis of all patients that was submitted to a maxillectomy for oncologic disease between 2008 and 2011 in our center. Results: The series consisted of 12 patients, 8 women and median age 57 years (range, 25-84). We realized Type IIA maxillectomy in five patients, IIB to two patients, IIIA to four patients and IIIB to one patient. We achieved R0 in all cases. The reconstruction was realized with obturator prosthesis in four patients, three patients with pedicled flaps and five patients were reconstructed with free flaps. All patients obtain an adequate functional status. One patient has partial flap loss. Discussion: Is recommended adjust the surgical choice to the patient prognosis. The obturator prosthesis is a good choice for selected group. The temporal muscle flap presents adequate functional results and is recommended in advanced disease and poor prognosis. The microsurgical reconstruction is the best choice with better functional and aesthetics outcomes in type II, III and IV maxillectomy.

Use of Temporalis Myofascial Flap in Maxillary Reconstruction

ABSTRACT Maxillary ameloblastoma is a benign odontogenic neoplasm. Excision should involve wide margins because of its high recurrence rate and ideally be followed by reconstruction. A 23 year-old female patient presented with recurrent ameloblastoma. One year previously, she had undergone a curettage excision. The recurrent lesion was managed by a total maxillectomy preserving the inferior orbital rim. Simultaneous reconstruction was performed with an temporalis myofascial flap for obliteration of the maxillary sinus and nasal cavities. Reconstruction of mid facial defects after tumor resection or trauma has evolved from skin graft to pedicled flaps and more recently, to free tissue transfer. Each of these reconstructive modalities has its specific indications, advantages and drawbacks. Temporalis muscle is one of the regional flaps that can be used to reconstruct midfacial defects. The muscle is available close to the surgical field and has a constant vascular supply. However, the flap has a limited arc of rotation and most of the muscle bulk is used in the pedicle. Therefore, various modifications of the surgical procedure were attempted in order to increase the arc of rotation of the flap. The temporalis muscle flap can provide a reliable, one-stage reconstructive alternative for more complicated surgical procedures for moderate-sized midfacial defects. Dimensions and arc of rotation of the flap may be increased by using temporalis muscle and deep temporal fascia as a myofascial unit. How to cite this article Nayak C, Swain SK. Use of Temporalis Myofascial Flap in Maxillary Reconstruction. Clin Rhinol An Int J 2014;7(2):73-75.

A five years review of maxillectomies: our experience

Introduction: Reconstruction of midface defects is a challenge for the oral and maxillofacial surgeon. Ablative surgery, due to tumour and traumatic cases, causes an alteration of the stomatognathic system.

Use of a titanium cutting guide to assist raising the composite radial forearm free flap

The use of composite radial free tissue transfer has been overtaken by other composite flaps. This is due to donor site morbidity and the poor volume of bone yielded. The advantages and potential complications of composite radial flaps are well described. Use of the composite radial forearm free flap has been largely superseded in mandible reconstruction, but applications such as a salvage option still exist. Additionally it may be used in the reconstruction of midface defects. The use of a cutting guide to reduce the donor site complications and yet produce a maximal yield of bone is described herein. With the use of a skilled maxillofacial laboratory, the planning allows precise cuts and placement of the free flap and allows accurate prophylactic plating of the radius. A precise titanium cutting guide and custom distal radius plate are used. Details of three cases where these techniques have been implemented are described. The paper demonstrates the significant advantages of using laboratory-based technology to assist in performing composite radial free flaps. This paper reveals that composite radial free tissue transfer still has a place in the reconstruction of very selective defects of the head and neck. In particular, its use in reconstruction of Class 5 and 6 maxillary defects (Brown classification) is illustrated. Correct case selection and planning results in increased confidence to use this flap.

Use of temporo-myofascial flap for reconstruction of maxillary defect in a case of ameloblastoma

Maxillary ameloblastoma is a benign odontogenic neoplasm. Excision should involve wide margins because of its high recurrence rate and, ideally, be followed by reconstruction. A 23-year-old female patient presented with recurrent ameloblastoma. The recurrent lesion was managed by a total maxillectomy preserving the inferior orbital rim. Reconstruction of midfacial defects after tumor resection or trauma has evolved from skin graft to pedicled flaps and more recently, to free tissue transfer. Each of these reconstructive modalities has its specific indications, advantages, and drawbacks. In our case simultaneous reconstruction was performed with a temporalis myofascial flap for obliteration of the maxillary sinus and nasal cavities. Temporalis muscle is one of the regional flaps that can be used to reconstruct midfacial defects. The muscle is available close to the surgical field and has a constant vascular supply. However, the flap has a limited arc of rotation and most of the muscle bulk is used in the pedicle. Therefore, various modifications of the surgical procedure were attempted in order to increase the arc of rotation of the flap. The temporalis muscle flap can provide a reliable, one-stage reconstructive alternative for more complicated surgical procedures for moderate-sized midfacial defects.

Tuberculosis of the Maxilla and Reconstruction of Midfacial Defect using Temporalis Muscle Flap

ABSTRACTTuberculosis of the maxillary sinus is a rare entity which may lead to bony erosion and fistula formation. In this case, we have described a patient of tuberculosis of maxilla, a relatively uncommon entity leading to marked bony erosion with fistula formation over face, which was reconstructed using temporalis muscle flap as a reliable and one-stage procedure alternative to more complicated surgical procedures for midfacial defects.How to cite this articleKumar S, Singh HP, Agarwal SP. Tuberculosis of the Maxilla and Reconstruction of Midfacial Defect using Temporalis Muscle Flap. Int J Head and Neck Surg 2012;3(1):49-52.

Cervicofacial Advancement‐Rotation Flap in Midface Reconstruction

To present the authors' experience and outcomes in the reconstruction of midfacial defects using cervicofacial advancement-rotation flaps (CARFs) based on a method of determining forward or reverse design in relation to the proportions of the defect. Case series with retrospective chart review. Tertiary care academic medical center. Patients who underwent CARF reconstruction and the subset of patients with midfacial defects medial to the lateral canthus were included. CARF was designed in a forward fashion with an anteromedial movement for the defects with a larger vertical dimension and in a reverse fashion with a posterosuperior movement for the defects with a larger horizontal dimension. Thirteen of 45 patients who underwent CARF reconstruction qualified for the analysis as a subset based on defect location. CARF was used in a forward fashion in 7 patients and in a reverse fashion in 6 patients. The largest defect in this subset was measured as 9 × 6 cm, while the smallest defect was 3 × 2 cm. Average follow-up was 11.5 months. None of the patients developed partial or total flap loss. Six patients had mild ectropion, which was managed with conservative measures only. The outcome of the reconstruction was satisfactory in all cases. Designing the CARF based on the proportion of the vertical and horizontal diameters of the selected midfacial defects as described allows for closure of the defects with minimal tension and minimizes the amount of discarded healthy skin overlapping at the suture lines.

O147. Reconstruction of mid-facial defect with free tissue transfer after surgery of nasal cavity and maxillary sinus cancer

O147. Reconstruction of mid-facial defect with free tissue transfer after surgery of nasal cavity and maxillary sinus cancer

Osteomyocutaneous deep circumflex iliac artery perforator flap in the reconstruction of midface defect with facial skin loss: A case report

We describe the value of the osteomyocutaneous deep circumflex iliac artery perforator (DCIAP) flap in the complex midface defect requiring oronasal, skeletal, and facial skin reconstruction. The skin island is thin and vascular pedicle is long and flexible enough to allow reconstruction of a variety of cutaneous defects. The DCIAP option offers an apparently excellent and complete reconstruction and good potential for subsequent rehabilitation, however can be raised synchronously with the ablative procedure and requires only one pair of anastamoses.