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Philip A. Pollice, MD; John L. Frodel, Jr, MD

Arch Otolaryngol Head Neck Surg. 1998;124:802-808.

Objective  To evaluate the aesthetic and functional results of secondary reconstruction of the upper midface and lower orbit following globe-sparing maxillectomy.

Design  Retrospective analysis.

Setting  University medical center.

Patients  Six patients, all having previously undergone globe-sparing maxillectomies with or without postoperative radiotherapy, were selected for secondary reconstruction of the upper midface.

Intervention  Free calvarial bone grafts (CBGs) alone or in conjunction with alloplastic material were used to reconstruct the upper midface and lower orbit both aesthetically and functionally. Bone grafts were secured using lag screw and nonrigid techniques. Pedicled temporoparietal fascia (TPF) flaps provided coverage of the reconstructions and internal lining of the maxillectomy cavity.

Outcome Measures  Aesthetic and functional results of upper midface and lower orbit as determined by preoperative and postoperative photographs and physical examination.

Results  All patients had considerable improvement in upper midfacial contours. All patients had improvement of globe position. Patients with diplopia before reconstruction noted improvement after reconstruction, although 1 patient continued to have moderate diplopia. Complications included persistent globe malposition, persistent diplopia, bone graft resorption, partial loss of 1 TPF flap, need for revision surgery, and subjectively worsened appearance in 1 patient.

Conclusions  Reconstruction with CBGs, alloplastic material, and TPF may reliably, effectively, and efficiently rehabilitate the functional and aesthetic upper midfacial deficits of select patients with secondary reconstruction after globe-sparing maxillectomy. However, patients with evidence of excessive scarring may benefit more from free-tissue transfer reconstruction.

From the Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Md. Dr Frodel is now with the Division of Otolaryngology and Plastic Surgery, Department of Surgery, The University of New Mexico Health Sciences Center, Albuquerque.

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