Benefits of routine maxillectomy and orbital reconstruction with the rectus abdominis free flap

Maxillary defects lead to functional and cosmetic deficiencies, especially with tumor invasion of the orbit and cribriform plate. Additionally problem atic is the near-total palatal resection in patients with poor dentition (i e, not useful for anchoring obturators) and the desire for return of deglut ition and useful speech. A series of 12 patients is presented in whom a rec tus abdominis free flap was used for reconstruction of the palate, maxilla, and/or orbit. Nine of 12 free flaps were used to reconstruct defects invol ving the maxilla and orbit; all were successful in restoring hard palate co ntinuity and function without the use of an obturator. The remaining 3 pati ents underwent successful repair of defects involving the orbit and medial maxilla without complication. Four of those 9 patients with palatal reconst ruction augmented their dental rehabilitation with either their existing up per denture plate or the use of a cosmetic appliance anchored to their rema ining dentition. Objectively, the rectus abdominis myocutaneous free flap p roved to be a reliable and expeditious method of restoring function and acc eptable cosmesis. We believe this technique should be routinely considered in the reconstruction of these defects.