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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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