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Iliac Crest Internal Oblique Osteomusculocutaneous Free Flap Reconstruction of the Postablative Palatomaxillary Defect
Eric M. Genden, MD;
Derrick Wallace, MD;
Daniel Buchbinder, DDS, MD;
Devin Okay, DDS;
Mark L. Urken, MD
Arch Otolaryngol Head Neck Surg. 2001;127:854-861.
Background Traditionally, restoration of extensive palatomaxillary defects have
been achieved by prosthetic restoration, often with suboptimal functional
results. More recently, vascularized bone-containing free flaps have been
used for this purpose.
Objective To describe 6 patients who underwent palatomaxillary reconstruction
using the composite iliac crest–internal oblique osteomusculocutaneous
free flap.
Methods Six cases of iliac crest osteomusculocutaneous free flap reconstruction
of extensive postablative palatomaxillary defects were retrospectively reviewed
with clinical follow-up. We reviewed these cases for pathologic findings,
defect size, dental restoration, oral rehabilitation, and speech.
Results Pathologic findings included squamous cell carcinoma (n = 4), osteogenic
sarcoma (n = 1), and sinonasal hemangiopericytoma (n = 1). Mean follow-up
was 14.5 months (range, 10-25 months). Four patients underwent resection and
reconstruction primarily and 2 underwent reconstruction secondarily. Two patients
required reconstruction of a cutaneous defect using the iliac skin paddle.
The hard palate and lateral nasal wall were reconstructed in all 6 patients,
and the orbital rim and zygomatic body were reconstructed in 4. One patient
underwent reconstruction with an orbital prosthesis supported by osseointegrated
implants. There was 1 donor site complication and 1 recipient site infection,
which was treated successfully with oral antibiotics. Four patients were rehabilitated
with osseointegrated implants, and all 6 patients maintain an unrestricted
oral diet. All 6 patients have normal speech without velopharyngeal or oronasal
insufficiency.
Conclusion For extensive palatomaxillary defects, the iliac crest–internal
oblique osteomusculocutaneous free flap offers a reliable method of primary
reconstruction, allowing for complete orodental rehabilitation without the
use of a prosthetic obturator.
From the Departments of Otolaryngology–Head and Neck Surgery
(Drs Genden, Wallace, and Urken) and Oral Maxillofacial Surgery and Dentistry
(Drs Buchbinder and Okay), The Mount Sinai Medical Center, New York, NY.
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Arch Otolaryngol Head Neck Surg. 2001;127(7):889-890.
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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Comparison of Functional and Quality-of-Life Outcomes in Patients With and Without Palatomaxillary Reconstruction: A Preliminary Report
Genden et al.
Arch Otolaryngol Head Neck Surg 2003;129:775-780.
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