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Maxillary reconstruction with free fibular myo-osteocutaneous flap in 67-year-old remodels to resemble native maxilla
Nichole E Zayan, BS
Theresa M Hofstede, DDS
Roman J Skoracki, MD
The Ohio State University College of Medicine
2018-01-29
Presenter: Nichole E Zayan
Affidavit:
The work of the student includes collaborating on the concept and design and all analysis, interpretation and drafts as outlined below.
Director Name: Roman J Skoracki
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Midface reconstruction of oncologic defects is one of the greatest challenges for reconstructive surgeons. The omega-shaped fibula osteocutaneous free flap has been described as suitable for midface reconstruction for its ability to restore the stable configuration of the midface, providing consistent functional and aesthetic outcomes; this is the reconstructive technique used in our patient. There are a few reported pediatric cases in the literature of bone remodeling after osteocutaneous free flaps, however, to our knowledge, this phenomenon has not been reported in adults. We present the case of a 67-year-old female with a history of stage T4N0 squamous cell carcinoma of the right gingiva with erosion of the inferior aspect of the hard palate and alveolar ridge of the right maxilla. The patient first underwent right infrastructural maxillectomy, was initially rehabilitated with an obturator, and then underwent radiation. Two years later, the patient required completion maxillectomy and underwent free fibular myo-osteocutaneous flap reconstruction in an omega configuration, which was later followed by osteointegrated implant placement into the fibula to allow for dental rehabilitation. In follow-up imaging, it was noted that the shape of the reconstructed maxilla gradually became more similar to the native maxilla. These findings suggest that the forces of mastication and structural support provided by the maxillae are sufficient to contribute to remodeling of the transferred bone to more closely resemble the native maxilla, even in the skeletally mature adult.
