The three Dimensional Facial Reconstruction of Maxillary Defects using Latissimus Dorsi Musculocutaneous Free Flaps

ABSTRACT

Surgical reconstruction of malignancies of the head and neck often leave large defects that demands reconstruction. A maxillectomy defect creates a communication from oral cavity to nasal cavity that may extend to the orbit. This can leave a large anatomical defect that invades surrounding anatomical boundaries including the oral cavity, nasal cavity, orbital cavity, soft tissues of the face, and anterior skull base. Surgical repair of maxillary defects has been widely reported. Skin graft, local and regional flaps such as local mucosal flaps, buccal fat pad, temporalis muscle and pectoralis major muscle pedicled flaps, and free tissue transfer can be used depending largely on the size of the defect. We performed facial reconstruction using a latissimus dorsi musculocutaneous free flap for covering large defects that involved exposed orbit, nasal, and oral cavities in seven patients after total maxillectomy for maxillary cancer. One case was immediate reconstruction and the others were secondary reconstruction during the follow up period after primary cancer surgery. The skin of the latissimus dorsi musculocutaneous flap was pliable and its texture was similar to that of the face. The muscle bulkiness was sufficient to reconstruct the soft tissue of the intraoral and nasal lining and external skin deficits. All flaps had survived and serious complications were not developed. None of the patients need secondary defatting procedures later for the excessive bulkiness, but oronasal fistulas developed in two patients and one patient had cicatrical ectropion of lower eyelid. All donor defects were closed primarily and there has been no noticeable residual functional problems or discomfort in the shoulder area.