Iliac crest internal oblique osteomusculocutaeous free flap reconstructionof the postablative palatomaxillary defect

Background: Traditionally, restoration of extensive palatomaxillary defects have been achieved by prosthetic restoration, often with suboptimal functi onal results I More recently, vascularized bone-containing free flaps have been used for this purpose. Objective: To describe 6 patients who underwent palatomaxillary reconstruct ion using the composite iliac crest-internal oblique osteomusculocutaneous free flap. Methods: Six cases of iliac crest osteomusculocutaneous free flap reconstru ction of extensive postablative palatomaxillary defects were retrospectivel y 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), osteog enic sarcoma (n=1), and sinonasal hemangiopericytoma (n=1). Mean follow-up was 14.5 months (range, 10-25 months). Four patients underwent resection an d 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 reci pient 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 spe ech without velopharyngeal or oronasal insufficiency. Conclusion: For extensive palatomaxillary defects, the iliac crest-internal oblique osteomusculocutaneous free flap offers a reliable method of primar y reconstruction, allowing for complete orodental rehabilitation without th e use of a prosthetic obturator.