Retrospective case series of primary and secondary microvascular free tissue transfer reconstruction of midfacial defects

Statement of problem. Midfacial defects arising from tumor extirpation or t rauma may involve any portion of the central area of the face, including th e palate, maxilla, orbit, lip, and/or nose. Speech, mastication, swallowing , and cosmesis are significantly impaired and present a unique challenge to the reconstructive surgeon. Purpose. This study evaluated the functional and cosmetic success of both s oft tissue and osteocutaneous free flap reconstruction of the midface, Material and methods. A retrospective chart review, of 34 patients who unde rwent primary and secondary free flap reconstruction of the midface was con ducted. The main Outcome measures were perioperative complications, diet, s peech intelligibility, type of dental restoration, and cosmetic result. Results. Fifteen patients underwent soft tissue free flap reconstruction of the midface. Six of these patients also had additional nonvascularized fre e cranial bone grafts to improve restoration of the orbitozygomatic region. Nineteen patients who might have required osseointegrated implants to anch or a dental prosthesis underwent osteocutaneous free flap reconstruction. T hirty-three of 34 free flaps survived, and wound complications were minimal . After surgery, 20 patients were able to cat a regular diet and 14 a soft diet. All patients had intelligible speech over the telephone. Ten patients used a dental prosthesis (5 conventional and 5 implant-borne). Cosmesis wa s judged to be excellent in 12 patients, good in 15 patients, fair in 5 pat ients, and poor in 2 patients. Conclusion. In the patients reviewed, free flap reconstruction of the midfa ce was completed in a single stage and created a reproducible, permanent se paration of the oral and sinonasal cavities with adequate speech and swallo wing.