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Douglas B. Chepeha, MD, MSPH; Jeffrey S. Moyer, MD; Carol R. Bradford, MD, MS; Mark E. Prince, MD; Lawrence Marentette, MD; Theodoros N. Teknos, MD

Arch Otolaryngol Head Neck Surg. 2005;131:513-517.

Objective  To evaluate the resulting aesthetics, function, and donor site morbidity of the osseocutaneous radial forearm free flap (OCRFFF) used for midface reconstruction.

Design  Prospective case series and a retrospective review of results.

Patients  Ten patients from an academic practice who underwent reconstruction at the University of Michigan Hospitals between 1995 and 2001.

Interventions  All patients had maxillectomy defects in which the entire infraorbital rim was reconstructed with an OCRFFF. Of the 10 patients included in the study, 3 underwent a total maxillectomy with orbital exenteration, 4 had a total maxillectomy without orbital exenteration, and 3 had a limited maxillectomy that did not involve the palate. Patients with palatal defects underwent reconstruction with a prosthetic palatal obturator.

Main Outcome Measures  Facial contour and aesthetic results, speech understandability, ability to eat solid foods, oronasal separation, socializing outside the home, and return-to-work status. Flap success, donor site morbidity, and orbital complications were also studied.

Results  Mean ± SEM follow-up was 23.2 ± 5.0 months. A modified Funk facial deformity scale was used, and 7 of the 10 patients had either no deformity or minimal deformity. The mean aesthetic score for these reconstructions was 2.1 ± 0.3 on a scale of 1 to 4, with 1 representing no deformity and 4 representing a severe deformity. All patients returned to a solid diet and had understandable speech, although patients who had an orbital exenteration trended to poorer scores. All patients socialized either frequently or occasionally outside the home, and all patients not retired or disabled prior to surgery returned to work.

Conclusion  The OCRFFF reconstruction of the infraorbital rim in patients with total maxillectomy defects and obturator of the palatal defect controls orbital complications and optimizes aesthetic outcome while achieving nearly normal palatal function.

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor.

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