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J Oral Maxillofac Surg. 2018 Sep 27. pii: S0278-2391(18)31089-9. doi: 10.1016/j.joms.2018.09.019. [Epub ahead of print]

The Biaxial Double-Barrel Fibula Flap-A Simplified Technique for Fibula Maxillary Reconstruction.

Author information

1
Assistant Clinical Professor, Maxillofacial Microvascular Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, Medical University of South Carolina, Charleston, SC; Previously, Fellow, Head and Neck Oncologic and Microvascular Reconstructive Surgery, Providence Cancer Center Head and Neck Institute, Portland, OR. Electronic address: baber.khatib@gmail.com.
2
Attending Head and Neck/Microvascular Surgeon, Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, Portland; Consultant, Head and Neck Institute, Portland, OR.
3
Director of Maxillofacial Trauma, Trauma Service, Legacy Emanuel Medical Center, Portland; Consultant, Head and Neck Institute, Portland, OR.
4
Medical Director, Providence Oral, Head and Neck Cancer Program and Clinic, Earle A. Chiles Research Institute at the Robert W. Franz Cancer Center, Providence Cancer Institute, Portland; Director, Fellowship in Head and Neck Oncologic and Microvascular Reconstructive Surgery, Head and Neck Institute, Portland, OR.
5
Director, Head and Neck Cancer Program, Legacy Good Samaritan Medical Center, Portland; Consultant, Head and Neck Institute, Portland, OR.

Abstract

PURPOSE:

Previously described techniques for microvascular fibula reconstruction of Brown Class II to IV maxillectomy defects are complex, require multiple osteotomies, result in a short pedicle, and inadequately reconstruct the dental alveolus in preparation for endosseous implants. This report describes a simplified technique for Brown Class II to IV defects that re-creates facial support, allows for dental reconstruction with appropriately positioned implants, and maintains adequate pedicle length.

MATERIALS AND METHODS:

A retrospective chart review was performed of all patients with Brown Class II to IV maxillectomy defects immediately reconstructed with a biaxial double-barrel fibula flap technique. The reconstructive surgeon evaluated each patient at least 1 month after reconstruction for enophthalmos, facial symmetry, nasal patency, satisfactory jaw position, deglutition, intelligible speech, and intraoperative need for vein grafting.

RESULTS:

The sample was composed of 6 patients (mean age, 54 yr; range, 33 to 78 yr; 67% women) who underwent reconstruction with the biaxial double-barrel fibula flap technique for Brown Class II to IV defects. None of these patients required vein grafting. None of these patients had flap failure. Diagnoses for these patients were a hybrid odontogenic tumor (n = 1), squamous cell carcinoma (n = 3), adenoid cystic carcinoma (n = 1), and sinonasal melanoma (n = 1). All 6 patients had excellent facial contour and malar projection, regular oral intake, 100% intelligible speech, and a new maxillary skeletal Class I relation without need for intraoperative vein grafting. One patient developed enophthalmos related to inferior rectus sacrifice and removal of orbital fat. Complications included development of nasal synechia and occlusion of the maxillary sinus ostium (n = 1).

CONCLUSIONS:

The biaxial double-barrel fibula flap technique achieves the goals of providing adequate facial support and an alveolar segment amenable to implant dentistry. It allows for intelligible speech, deglutition, orbital support, and separation of the oronasal, orbital, and sinus cavities. In addition, it minimizes the need for vein grafting.

PMID:
30347200
DOI:
10.1016/j.joms.2018.09.019

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