Maxillectomy Reconstruction with Various Flaps: Preliminary Results and Suggested Algorithm

Objectives: Although maxillary reconstruction after maxillectomy for the malignant tumor is still controversial, various reconstruction techniques have been introduced. Since reconstruction methods could be varied by the defects and surgeon's preference, we would like to share our reconstruction algorithm and show preliminary results. Methods: Thirteen cases of maxillectomy reconstruction during the past 18 months were reviewed. The types of defects, reconstruction methods, and outcomes were reviewed. The types of defects after maxillectomy were as various as Brown class IIa, IIb, IIIb, IIId, IVb, IVd, and V. Reconstructions were performed using free flaps from the iliac crest, radial forearm, rectus abdominis, and latissimus dorsi. When the maxillectomy included orbital exentration, soft tissue free flaps for defects were preferred. On the other hand, defects for bony lesions including alveolar ridge and orbital rim were reconstructed with iliac crest osteomuscular (or osteomusculocutaneous) free flap. Results: All of them were well reconstructed without any complication. The content, especially the orbital content and bony structure, and size of the maxillectomy defect, tumor characteristics, and patients’ prognosis should be considered in the selection of maxillectomy reconstruction. Conclusions: The iliac crest free flap might be one of the best options to reconstruct the bony defect after maxillectomy.