Maxillary reconstruction using vascularized fibular osteomyocutaneous flap and iliac bone through modified lateral lip-submandibular approach.

OBJECTIVES: The objective of this study was to demonstrate total maxillary reconstruction using 1 vascularized fibular osteomyocutaneous flap segment alone and nonvascularized iliac crest bone through the modified lateral lip-submandibular approach. At the same time, three-dimensional virtual technology was performed as well.

METHODS: Nine patients suffering from total maxillary defects, who had undergone maxillary reconstruction using 1 vascularized fibular osteomyocutaneous flap segment and nonvascularized iliac bone through the modified lateral lip-submandibular approach, were reviewed for this study. Before the surgery, patients' computed tomography scan data were virtually analyzed using SimPlant Pro software (version 11.04).

RESULTS: Healing courses were uneventful in all patients; acceptable maxillomandibular relationship, mouth opening, and speech were assessed as normal in all. There were no long-term functional limitations of the lower limb, even though all complain of dysfunction of the first toe, which developed the deformity of the claw toe in the end. Other complications did not occur such as diplopia, ectropion, flap necrosis, facial paralysis, and sensory numbness in the lower lip.

CONCLUSIONS: The maxillary reconstruction using 1 vascularized fibular osteomyocutaneous flap segment and nonvascularized iliac crest bone through the modified lateral lip-submandibular approach is a feasible and acceptable technique because of multiple advantages. Combined with the three-dimensional virtual technology, the technique can improve the postoperative outcomes.