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Orbital Floor Reconstruction with Free Flaps after Maxillectomy

Leela Mohan C. S. R. Sampathirao, MS, MCh,1 Krishnakumar Thankappan, MS, DNB, MCh,1 Sriprakash Duraisamy, MS, MCh,1 Naveen Hedne, MS, MCh,1 Mohit Sharma, MS, MCh,1 Jimmy Mathew, MS, MCh,1 and Subramania Iyer, MS, MCh, FRCS1

Results

One hundred twenty-six patients underwent maxillectomy during the study period. Combined modality treatment with surgery followed by radiotherapy with or with or out chemotherapy was performed. Thirty-nine patients had total maxillectomy including orbital floor removal. 

Brown’s classification1 was utilized to type the defects after resection. All patients in this study had class III defects. Free flaps were used for reconstruction of the defects, to achieve oroantral or oronasal separation and to support the orbital contents. Of the 39 patients who had total maxillectomy including orbital floor removal, 34 underwent free tissue reconstruction of the orbital floor and the remaining five had regional flap reconstruction. Twenty-six patients underwent bony reconstruction and eight patients had only a soft tissue reconstruction. Patients with soft tissue reconstruction had some remnant posterior floor of the orbit after resection. Free fibula flap (FFF) was used in 14 patients, tensor fascia lata (TFL) with iliac crest (IC) was used in 9 patients, 1 patient underwent reconstruction with radial artery forearm free flap with bone, and 1 patient had free latissimus dorsi with rib.

Fig. 1A, B, C, D shows the maxillectomy defect and the reconstructed outcome in a patient where FFF was used. Fig. 2A, B, C, D shows the reconstructive outcome of a patient who underwent maxillectomy and reconstruction with TFL-IC flap. Eight patients had a soft tissue reconstruction. Rectus abdominis free flap was used in six. The fascia of the flap was used as a sling for the orbital contents. Fig. 3A, B shows the reconstructive outcome in patient in whom rectus abdominis flap was used. Radial artery forearm free flap without bone was used in two. A Prolene mesh shaped and attached like a sling was used for the orbital support in these two cases.

Orbital Floor Reconstruction with Free Flaps after Maxillectomy
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Figure 1
(A) Intraoperative photograph showing total maxillectomy defect with orbital contents preserved. (B) Outcome at 2 years’ follow-up in a patient reconstructed with free fibula osteocutaneous flap, frontal view. (C) Reconstructed outcome, lateral view. (D) Outcome at 2 years’ follow-up, three-dimensional reconstructed computed tomographic imag

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