Skip to main content
SpringerLink
Log in

Current Concepts in Maxillary Reconstruction

  • Chapter
  • First Online:
Contemporary Oral Oncology

  • 1664 Accesses

Abstract

The concepts in maxillary reconstruction are still evolving when compared to the reconstruction of the mandible. Maxillary defects affect the functions of the speech, swallowing, and mastication and also cause cosmetic disfigurement. Rehabilitation of the maxillary defects is either possible by using an obturator prosthesis or by a surgical reconstruction. A variety of reconstructive methods are available. The classification systems are also many, none universally accepted. The oncologic safety of these procedures is still debated and conclusive evidence in this regard has not emerged yet. Management of the defects of the orbit associated with maxillectomy is an area yet to be solved. Tissue engineering, though thought to be one of the possible solutions for this reconstructive problem, has not come out with reliable and reproducible results yet. This chapter discusses the rationale and oncological safety of reconstructing the maxillary defects, critically analyzes the classification systems, and discusses the different reconstructive methods and controversies in this scenario. The management of the retained and exenterated orbit associated with maxillectomy is reviewed. The surgical morbidity, complications, and the recent advances in this field are also looked into. An algorithm, based on our experience, is presented.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Parr GR, Tharp GE, Rahn AO. Prosthodontic principles in the framework design of maxillary obturator prostheses. J Prosthet Dent. 1989;62:205–12.

    CAS  PubMed  Google Scholar 

  2. Eckert SE, Carr AB. Implant-retained maxillary overdentures. Dent Clin North Am. 2004;48:585–601, v.

    PubMed  Google Scholar 

  3. Cordeiro PG, Santamaria E, Kraus DH, Strong EW, Shah JP. Reconstruction of total maxillectomy defects with preservation of the orbital contents. Plast Reconstr Surg. 1998;102:1874–84; discussion 1885–1887.

    CAS  PubMed  Google Scholar 

  4. Kornblith AB, Zlotolow IM, Gooen J, Huryn JM, Lerner T, Strong EW, et al. Quality of life of maxillectomy patients using an obturator prosthesis. Head Neck. 1996;18(4):323–34 [Internet]. [cited 2013 Nov 10].

    CAS  PubMed  Google Scholar 

  5. Rogers SN, Lowe D, McNally D, Brown JS, Vaughan ED. Health-related quality of life after maxillectomy: a comparison between prosthetic obturation and free flap. J Oral Maxillofac Surg. 2003;61:174–81.

    PubMed  Google Scholar 

  6. Okay DJ, Genden E, Buchbinder D, Urken M. Prosthodontic guidelines for surgical reconstruction of the maxilla: a classification system of defects. J Prosthet Dent. 2001;86:352–63.

    CAS  PubMed  Google Scholar 

  7. Moreno MA, Skoracki RJ, Hanna EY, Hanasono MM. Microvascular free flap reconstruction versus palatal obturation for maxillectomy defects. Head Neck. 2010;32(7):860–8 [Internet]. [cited 2013 Nov 10].

    PubMed  Google Scholar 

  8. Genden EM, Wallace DI, Okay D, Urken ML. Reconstruction of the hard palate using the radial forearm free flap: indications and outcomes. Head Neck. 2004;26(9):808–14.

    PubMed  Google Scholar 

  9. Chigurupati R, Aloor N, Salas R, Schmidt BL. Quality of life after maxillectomy and prosthetic obturator rehabilitation. J Oral Maxillofac Surg. 2013;71(8):1471–8 [Internet]. [cited 2013 Nov 8].

    PubMed  Google Scholar 

  10. Genden EM, Okay D, Stepp MT, Rezaee RP, Mojica JS, Buchbinder D, et al. Comparison of functional and quality-of-life outcomes in patients with and without palatomaxillary reconstruction: a preliminary report. Arch Otolaryngol Head Neck Surg. 2003;129(7):775–80 [Internet]. [cited 2013 Nov 10].

    PubMed  Google Scholar 

  11. Brown JS, Rogers SN, McNally DN, Boyle M. A modified classification for the maxillectomy defect. Head Neck. 2000;22:17–26.

    CAS  PubMed  Google Scholar 

  12. Brown JS, Shaw RJ. Reconstruction of the maxilla and midface: introducing a new classification. Lancet Oncol. 2010;11(10):1001–8 [Internet]. Elsevier Ltd; [cited 2013 Oct 7].

    PubMed  Google Scholar 

  13. Cordeiro PG, Santamaria E. A classification system and algorithm for reconstruction of maxillectomy and midfacial defects. Plast Reconstr Surg. 2000;105(7):2331–46.

    CAS  PubMed  Google Scholar 

  14. Santamaria E, Cordeiro PG. Reconstruction of maxillectomy and midfacial defects with free tissue transfer. J Surg Oncol. 2006;94(6):522–31.

    PubMed  Google Scholar 

  15. Cordeiro PG, Chen CM. A 15-year review of midface reconstruction after total and subtotal maxillectomy: part I. Algorithm and outcomes. Plast Reconstr Surg. 2012;129(1):124–36 [Internet]. [cited 2013 Sep 24].

    CAS  PubMed  Google Scholar 

  16. Triana RJ, Uglesic V, Virag M, Varga SG, Knezevic P, Milenovic A, et al. Microvascular free flap reconstructive options in patients with partial and total maxillectomy defects. Arch Facial Plast Surg. 2000;2(2):91–101 [Internet]. American Medical Association; [cited 2013 Nov 10].

    PubMed  Google Scholar 

  17. McCarthy CM, Cordeiro PG. Microvascular reconstruction of oncologic defects of the midface. Plast Reconstr Surg. 2010;126(6):1947–59 [Internet]. [cited 2013 Nov 10].

    CAS  PubMed  Google Scholar 

  18. Hanasono MM, Utley DS, Goode RL. The temporalis muscle flap for reconstruction after head and neck oncologic surgery. Laryngoscope. 2001;111:1719–25.

    CAS  PubMed  Google Scholar 

  19. Caubet Biayna J, Iriarte Ortabe JI, Pueyo J. Reconstruction of a palatal defect with pedicled myomucosal flap of buccinator muscle. An Otorrinolaringol Ibero Am. 1998;25(3):263–70.

    CAS  PubMed  Google Scholar 

  20. Van Lierop AC, Fagan JJ. Buccinator myomucosal flap: clinical results and review of anatomy, surgical technique and applications. J Laryngol Otol. 2008;122:181–7.

    PubMed  Google Scholar 

  21. Amin MA, Bailey BMW, Swinson B, Witherow H. Use of the buccal fat pad in the reconstruction and prosthetic rehabilitation of oncological maxillary defects. Br J Oral Maxillofac Surg. 2005;43:148–54.

    CAS  PubMed  Google Scholar 

  22. Rapidis AD, Alexandridis CA, Eleftheriadis E, Angelopoulos AP. The use of the buccal fat pad for reconstruction of oral defects: review of the literature and report of 15 cases. J Oral Maxillofac Surg. 2000;58:158–63.

    CAS  PubMed  Google Scholar 

  23. You Y-H, Chen W-L, Wang Y-P, Liang J, Zhang D-M. Reverse facial-submental artery island flap for the reconstruction of maxillary defects after cancer ablation. J Craniofac Surg. 2009;20:2217–20.

    PubMed  Google Scholar 

  24. Wang J-G, Chen W-L, Ye H-S, Yang Z-H, Chai Q. Reverse facial artery-submental artery deepithelialised submental island flap to reconstruct maxillary defects following cancer ablation. J Craniomaxillofac Surg. 2011;39:499–502.

    PubMed  Google Scholar 

  25. Clauser L, Curioni C, Spanio S. The use of the temporalis muscle flap in facial and craniofacial reconstructive surgery. A review of 182 cases. J Craniomaxillofac Surg. 1995;23:203–14.

    CAS  PubMed  Google Scholar 

  26. Cheung LK, Samman N, Tideman H. Temporalis myofascial flap in maxillofacial reconstruction: clinical and histological studies of the oral healing process. Br J Oral Maxillofac Surg. 1997;35:406–12.

    CAS  PubMed  Google Scholar 

  27. Butler CE, Lewin JS. Reconstruction of large composite oromandibulomaxillary defects with free vertical rectus abdominis myocutaneous flaps. Plast Reconstr Surg. 2004;113:499–507.

    PubMed  Google Scholar 

  28. Zaretski A, Wei F-C, Lin C-H, Cheng M-H, Tsao C-K, Wallace CG. Anterolateral thigh perforator flaps in head and neck reconstruction. Semin Plast Surg. 2006;20:64–72.

    PubMed Central  Google Scholar 

  29. Rodríguez-Vegas JM, Angel PA, Manuela PR. Refining the anterolateral thigh free flap in complex orbitomaxillary reconstructions. Plast Reconstr Surg. 2008;121(2):481–6 [Internet]. [cited 2013 Nov 10].

    PubMed  Google Scholar 

  30. Zhang B, Li D-Z, Xu Z-G, Tang P-Z. Deep inferior epigastric artery perforator free flaps in head and neck reconstruction. Oral Oncol. 2009;45:116–20 [Internet].

    PubMed  Google Scholar 

  31. Chana JS, Wei F-C. A review of the advantages of the anterolateral thigh flap in head and neck reconstruction. Br J Plast Surg. 2004;57(7):603–9 [Internet]. [cited 2013 Nov 10].

    PubMed  Google Scholar 

  32. Bianchi B, Ferri A, Ferrari S, Copelli C, Sesenna E. Maxillary reconstruction using anterolateral thigh flap and bone grafts. Microsurgery. 2009;29(6):430–6.

    PubMed  Google Scholar 

  33. Bianchi B, Bertolini F, Ferrari S, Sesenna E. Maxillary reconstruction using rectus abdominis free flap and bone grafts. Br J Oral Maxillofac Surg. 2006;44(6):526–30.

    PubMed  Google Scholar 

  34. Hashikawa K, Tahara S, Ishida H, Yokoo S, Sanno T, Terashi H, et al. Simple reconstruction with titanium mesh and radial forearm flap after globe-sparing total maxillectomy: a 5-year follow-up study. Plast Reconstr Surg. 2006;117:963–7.

    CAS  PubMed  Google Scholar 

  35. Schubert W, Gear AJL, Lee C, Hilger PA, Haus E, Migliori MR, et al. Incorporation of titanium mesh in orbital and midface reconstruction. Plast Reconstr Surg. 2002;110:1022–30; discussion 1031–1032.

    PubMed  Google Scholar 

  36. Sun G, Yang X, Tang E, Wen J, Lu M, Hu Q. Palatomaxillary reconstruction with titanium mesh and radial forearm flap. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108:514–9.

    PubMed  Google Scholar 

  37. Nakayama B, Hasegawa Y, Hyodo I, Ogawa T, Fujimoto Y, Kitano H, et al. Reconstruction using a three-dimensional orbitozygomatic skeletal model of titanium mesh plate and soft-tissue free flap transfer following total maxillectomy. Plast Reconstr Surg. 2004;114(3):631–9.

    PubMed  Google Scholar 

  38. Dediol E, Uglešić V, Zubčić V, Knežević P. Brown class III maxillectomy defects reconstruction with prefabricated titanium mesh and soft tissue free flap. Ann Plast Surg. 2013;71(1):63–7 [Internet]. [cited 2013 Nov 10].

    CAS  PubMed  Google Scholar 

  39. Curioni C, Toscano P, Fioretti C, Salerno G. Reconstruction of the orbital floor with the muscle-bone flap (temporal muscle with coronoid process). J Maxillofac Surg. 1983;11:263–8.

    CAS  PubMed  Google Scholar 

  40. Pryor SG, Moore EJ, Kasperbauer JL, Hayden RE, Strome SE. Coronoid-temporalis pedicled rotation flap for orbital floor reconstruction of the total maxillectomy defect. Laryngoscope. 2004;114(11):2051–5.

    PubMed  Google Scholar 

  41. Bilen BT, Kilinç H, Arslan A, Aslan S. Reconstruction of orbital floor and maxilla with divided vascularised calvarial bone flap in one session. J Plast Reconstr Aesthet Surg. 2006;59:1305–11.

    PubMed  Google Scholar 

  42. Ye J, Yang Z, Zhang D, Chen W, Zhou M. Maxillary functional reconstruction using a reverse facial artery–submental artery mandibular osteomuscular flap with dental implants. J Oral Maxillofac Surg. 2011;69(11):2909–14.

    PubMed  Google Scholar 

  43. Choung PH, Nam IW, Kim KS. Vascularized cranial bone grafts for mandibular and maxillary reconstruction. The parietal osteofascial flap. J Craniomaxillofac Surg. 1991;19:235–42.

    CAS  PubMed  Google Scholar 

  44. Chang DW, Langstein HN. Use of the free fibula flap for restoration of orbital support and midfacial projection following maxillectomy. J Reconstr Microsurg. 2003;19(3):147–52.

    PubMed  Google Scholar 

  45. Nakayama B, Matsuura H, Hasegawa Y, Ishihara O, Hasegawa H, Torii S. New reconstruction for total maxillectomy defect with a fibula osteocutaneous free flap. Br J Plast Surg. 1994;47(4):247–9.

    CAS  PubMed  Google Scholar 

  46. Yim KK, Wei FC. Fibula osteoseptocutaneous free flap in maxillary reconstruction. Microsurgery. 1994;15:353–7.

    CAS  PubMed  Google Scholar 

  47. Futran ND, Wadsworth JT, Villaret D, Farwell DG. Midface reconstruction with the fibula free flap. Arch Otolaryngol Head Neck Surg. 2002;128:161–6.

    PubMed  Google Scholar 

  48. Gilbert RW, Miles BA. Maxillary reconstruction with the scapular angle osteomyogenous free flap. Arch Otolaryngol Head Neck Surg. 2011;137(11):1130–5.

    PubMed  Google Scholar 

  49. Clark JR, Vesely M, Gilbert R. Scapular angle osteomyogenous flap in postmaxillectomy reconstruction: defect, reconstruction, shoulder function, and harvest technique. Head Neck. 2008;30:10–20.

    PubMed  Google Scholar 

  50. Granick MS, Ramasastry SS, Newton ED, Solomon MP, Hanna DC, Kaltman S. Reconstruction of complex maxillectomy defects with the scapular-free flap. Head Neck. 1990;12(5):377–85 [Internet]. [cited 2013 Nov 10].

    CAS  PubMed  Google Scholar 

  51. Brown JS, Jones DC, Summerwill A, Rogers SN, Howell RA, Cawood JI, et al. Vascularized iliac crest with internal oblique muscle for immediate reconstruction after maxillectomy. Br J Oral Maxillofac Surg. 2002;40(3):183–90 [Internet]. [cited 2013 Oct 7].

    CAS  PubMed  Google Scholar 

  52. Genden EM, Wallace D, Buchbinder D, Okay D, Urken ML. Iliac crest internal oblique osteomusculocutaneous free flap reconstruction of the postablative palatomaxillary defect. Arch Otolaryngol Head Neck Surg. 2001;127:854–61.

    CAS  PubMed  Google Scholar 

  53. Bianchi B, Ferri A, Ferrari S, Copelli C, Boni P, Sesenna E. Iliac crest free flap for maxillary reconstruction. J Oral Maxillofac Surg. 2010;68(11):2706–13.

    PubMed  Google Scholar 

  54. Chepeha DB, Moyer JS, Bradford CR, Prince ME, Marentette L, Teknos TN. Osseocutaneous radial forearm free tissue transfer for repair of complex midfacial defects. Arch Otolaryngol Head Neck Surg. 2005;131:513–7.

    PubMed  Google Scholar 

  55. Andrades P, Rosenthal EL, Carroll WR, Baranano CF, Peters GE. Zygomatic-maxillary buttress reconstruction of midface defects with the osteocutaneous radial forearm free flap. Head Neck. 2008;30:1295–302.

    PubMed  Google Scholar 

  56. Chatni S, Kuriakose MA, Iyer S. Free tensor fascia lata-iliac crest osteomusculocutaneous flap for reconstruction of combined maxillectomy and orbital floor defect. Ann Plast Surg. 2012;68(1):52–7.

    PubMed  Google Scholar 

  57. Sekido M, Yamamoto Y, Makino S. Maxillary reconstruction using a free deep inferior epigastric perforator (DIEP) flap combined with vascularised costal cartilages. J Plast Reconstr Aesthet Surg. 2006;59(12):1350–4.

    PubMed  Google Scholar 

  58. Iyer S, Thankappan K, Kuriakose MA, Sampathirao LMCSR, Mathew J, Sharma M. Tensor fascia lata-iliac crest-internal oblique free flap for composite orbito-maxillary defect with orbital exenteration. J Plast Reconstr Aesthet Surg. 2013;66(4):e116–8 [Internet]. [cited 2013 Oct 7].

    PubMed  Google Scholar 

  59. Kademani D, Mardini S, Moran SL. Reconstruction of head and neck defects: a systematic approach to treatment. Semin Plast Surg. 2008;22:141–55.

    PubMed  PubMed Central  Google Scholar 

  60. Brown JS. Deep circumflex iliac artery free flap with internal oblique muscle as a new method of immediate reconstruction of maxillectomy defect. Head Neck. 1996;18(5):412–21 [Internet].

    CAS  PubMed  Google Scholar 

  61. O’Connell DA, Futran ND. Reconstruction of the midface and maxilla. Curr Opin Otolaryngol Head Neck Surg. 2010;18:304–10.

    PubMed  Google Scholar 

  62. Ilankovan V, Ramchandani P, Walji S, Anand R. Reconstruction of maxillary defects with serratus anterior muscle and angle of the scapula. Br J Oral Maxillofac Surg. 2011;49:53–7.

    CAS  PubMed  Google Scholar 

  63. Mücke T, Hölzle F, Loeffelbein DJ, Ljubic A, Kesting M, Wolff K-D, et al. Maxillary reconstruction using microvascular free flaps. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111:51–7.

    PubMed  Google Scholar 

  64. Frodel JL, Funk GF, Capper DT, Fridrich KL, Blumer JR, Haller JR, et al. Osseointegrated implants: a comparative study of bone thickness in four vascularized bone flaps. Plast Reconstr Surg. 1993;92:449–55; discussion 456–458.

    PubMed  Google Scholar 

  65. Kademani D, Salinas T, Moran SL. Medial femoral periosteal microvascular free flap: a new method for maxillary reconstruction. J Oral Maxillofac Surg. 2009;67(3):661–5 [Internet]. [cited 2013 Nov 10].

    PubMed  Google Scholar 

  66. Iyer S, Chatni S, Kuriakose MA. Free tensor fascia lata-iliac crest osteomusculocutaneous flap for reconstruction of combined maxillectomy and orbital floor defect. Ann Plast Surg. 2012;68(1):52–7 [Internet]. [cited 2013 Oct 7].

    CAS  PubMed  Google Scholar 

  67. Haug RH, Nuveen E, Bredbenner T. An evaluation of the support provided by common internal orbital reconstruction materials. J Oral Maxillofac Surg. 1999;57(5):564–70 [Internet]. [cited 2013 Nov 10].

    CAS  PubMed  Google Scholar 

  68. Cinar C, Arslan H, Ogur S, Kilic A, Bingol UA, Yucel A. Free rectus abdominis myocutaneous flap with anterior rectus sheath to provide the orbital support in globe-sparing total maxillectomy. J Craniofac Surg. 2006;17(5):986–91.

    PubMed  Google Scholar 

  69. Lee HB, Hong JP, Kim KT, Chung YK, Tark KC, Bong JP. Orbital floor and infraorbital rim reconstruction after total maxillectomy using a vascularized calvarial bone flap. Plast Reconstr Surg. 1999;104:646–53.

    CAS  PubMed  Google Scholar 

  70. Sampathirao L, Thankappan K, Duraisamy S, Hedne N, Sharma M, Mathew J, et al. Orbital floor reconstruction with free flaps after maxillectomy. Craniomaxillofac Trauma Reconstr. 2013;06(02):099–106 [Internet]. Thieme Medical Publishers; [cited 2013 Nov 10].

    Google Scholar 

  71. Sarukawa S, Sakuraba M, Asano T, Yano T, Kimata Y, Hayashi R, et al. Immediate maxillary reconstruction after malignant tumor extirpation. Eur J Surg Oncol. 2007;33:518–23.

    CAS  PubMed  Google Scholar 

  72. Hanasono MM, Silva AK, Yu P, Skoracki RJ. A comprehensive algorithm for oncologic maxillary reconstruction. Plast Reconstr Surg. 2013;131(1):47–60.

    CAS  PubMed  Google Scholar 

  73. Hanasono MM, Lee JC, Yang JS, Skoracki RJ, Reece GP, Esmaeli B. An algorithmic approach to reconstructive surgery and prosthetic rehabilitation after orbital exenteration. Plast Reconstr Surg. 2009;123(1):98–105 [Internet]. [cited 2013 Oct 7].

    CAS  PubMed  Google Scholar 

  74. Banks ND, Hui-Chou HG, Tripathi S, Collins BJ, Stanwix MG, Nam AJ, Rodriguez ED. An anatomical study of external carotid artery vascular territories in face and midface flaps for transplantation. Plast Reconstr Surg. 2009;123(6):1677–87.

    CAS  PubMed  Google Scholar 

  75. Niu X-G, Zhao Y-M, Han X-X. Multiplanar and combined distraction osteogenesis for three-dimensional and functional reconstruction of unilateral large maxillary defects. Br J Oral Maxillofac Surg. 2009;47:106–10.

    PubMed  Google Scholar 

  76. Sándor GK, Tuovinen VJ, Wolff J, Patrikoski M, Jokinen J, Nieminen E, et al. Adipose stem cell tissue-engineered construct used to treat large anterior mandibular defect: a case report and review of the clinical application of good manufacturing practice-level adipose stem cells for bone regeneration. J Oral Maxillofac Surg. 2013;71(5):938–50 [Internet]. [cited 2013 Nov 11].

    PubMed  Google Scholar 

  77. Mesimäki K, Lindroos B, Törnwall J, Mauno J, Lindqvist C, Kontio R, et al. Novel maxillary reconstruction with ectopic bone formation by GMP adipose stem cells. Int J Oral Maxillofac Surg. 2009;38(3):201–9.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Head and Neck Surgery and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, India

    Subramania Iyer & Krishnakumar Thankappan

Authors
  1. Subramania Iyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Krishnakumar Thankappan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Subramania Iyer .

Editor information

Editors and Affiliations

  1. Department of Head and Neck Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, USA

    Moni Abraham Kuriakose

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Iyer, S., Thankappan, K. (2017). Current Concepts in Maxillary Reconstruction. In: Kuriakose, M.A. (eds) Contemporary Oral Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-43854-2_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-43854-2_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43852-8

  • Online ISBN: 978-3-319-43854-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation