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Review
. 2020 May;34(2):77-85.
doi: 10.1055/s-0040-1709470. Epub 2020 May 6.

Reconstruction of the Midface and Palate

Adam Bender-Heine  1 , Mark K Wax  1
Affiliations
Review

Reconstruction of the Midface and Palate

Adam Bender-Heine et al. Semin Plast Surg. 2020 May.

Abstract

The midface is a complex anatomic structure that is fundamental to many physiologic and homeostatic functions. It may be involved in many pathologic processes that require partial or complete removal. When this happens, reconstruction is mandatory to improve cosmetic outcome with its effect on social interaction as well as to provide an opportunity for complete orodental rehabilitation with restoration of all physiologic functions. This article will review the different reconstructive options available for complex defects of the maxillofacial complex. It will highlight the surgical options available to maximize functional restoration. Finally, it will discuss computer modeling to optimize reconstructive planning.

Keywords: dental rehabilitation; free tissue transfer; maxilla; maxillofacial reconstruction; surgical reconstruction.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
This photograph demonstrates a total maxillectomy defect.
Fig. 2
Fig. 2
( A ) This patient has had a partial maxillectomy with orbital exenteration. ( B ) An extensive maxillofacial prosthesis demonstrates reconstruction with this technology.
Fig. 3
Fig. 3
Reconstruction of a hard palate defect completed with a radial forearm free flap.
Fig. 4
Fig. 4
( A ) A partial maxillectomy of the hard palate and infrastructure of the maxilla has resulted in this defect. ( B ) The defect repaired with a double barrel radial forearm flap to provide for dental rehabilitation and separation of the oral cavity and the sinuses.
Fig. 5
Fig. 5
This photograph demonstrates a class III maxillectomy with loss of the orbital floor.
Fig. 6
Fig. 6
( A–C ) These three views of the postoperative CT scan demonstrate the reconstruction of the defect with a fibula flap. A segment of the fibula used to reconstruct the orbital rim, the maxillary buttress, and the inferior maxilla. An orbital plate used to support the adnexal contents.
Fig. 7
Fig. 7
( A ) A three-dimensional rendering is used to plan the osteotomies for the ablation. ( B ) The fibula bone used to reconstruct the various bony buttresses. Osteotomies made virtually.
Fig. 8
Fig. 8
A cutting jig manufactured to guide the closing osteotomies and simplify the process of fitting the bone to the defect.
Fig. 9
Fig. 9
The result seen on the computer planning and fits in perfectly with the defect guided by the planning session.
See this image and copyright information in PMC

References

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