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Retrospective case series of primary and secondary microvascular free tissue transfer reconstruction of midfacial defects.

STATEMENT OF PROBLEM
Midfacial defects arising from tumor extirpation or trauma may involve any portion of the central area of the face, including the palate, maxilla, orbit, lip, and/or nose. Speech, mastication, swallowing, and cosmesis are significantly impaired and present a unique challenge to the reconstructive surgeon.


PURPOSE
This study evaluated the functional and cosmetic success of both soft tissue and osteocutaneous free flap reconstruction of the midface.


MATERIAL AND METHODS
A retrospective chart review of 34 patients who underwent primary and secondary free flap reconstruction of the midface was conducted. The main outcome measures were perioperative complications, diet, speech intelligibility, type of dental restoration, and cosmetic result.


RESULTS
Fifteen patients underwent soft tissue free flap reconstruction of the midface. Six of these patients also had additional nonvascularized free cranial bone grafts to improve restoration of the orbitozygomatic region. Nineteen patients who might have required osseointegrated implants to anchor a dental prosthesis underwent osteocutaneous free flap reconstruction. Thirty-three of 34 free flaps survived, and wound complications were minimal. After surgery, 20 patients were able to eat a regular diet and 14 a soft diet. All patients had intelligible speech over the telephone. Ten patients used a dental prosthesis (5 conventional and 5 implant-borne). Cosmesis was judged to be excellent in 12 patients, good in 15 patients, fair in 5 patients, and poor in 2 patients.


CONCLUSION
In the patients reviewed, free flap reconstruction of the midface was completed in a single stage and created a reproducible, permanent separation of the oral and sinonasal cavities with adequate speech and swallowing.